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NPI Code Detail

MEDICARE: CHARLESTON ENT ASSOCIATES LLC

MEDICARE: CHARLESTON ENT ASSOCIATES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332900000XNon-Pharmacy Dispensing Site

General Provider Information

NPI Number : 1235576711
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLESTON ENT ASSOCIATES LLC
Provider Business Mailing Address
First Line : 2295 HENRY TECKLENBURG DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-7801
Country : US
Telephone Number : 843-793-6402
Fax Number :
Provider Business Practice Location Address
First Line : 3510 N HIGHWAY 17
Second Line : 135
City : MT PLEASANT
State : SC
Zip : 29466-8227
Country : US
Telephone Number : 843-654-7494
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF PHARMACY
Name : MR. JAMES VECCHIOLLA
Credential :
Telephone Number : 843-793-6402
Provider Enumeration Date : 05/24/2013
Last Update Date : 05/24/2013

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Directions to “CHARLESTON ENT ASSOCIATES LLC ” Practice Location

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