MEDICARE: DELTA OF HOLLYWOOD 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
1	3336C0003X	Community/Retail Pharmacy	16077	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2152922	OTHER		PK

General Provider Information

NPI Number	:	1356726798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA OF HOLLYWOOD LLC

Provider Business Mailing Address
First Line	:	402 E MAIN ST
Second Line	:
City	:	MONCKS CORNER
State	:	SC
Zip	:	29461-3616
Country	:	US
Telephone Number	:	843-761-5255
Fax Number	:	843-899-4970

Provider Business Practice Location Address
First Line	:	6251 HIGHWAY 162
Second Line	:
City	:	HOLLYWOOD
State	:	SC
Zip	:	29449-5782
Country	:	US
Telephone Number	:	843-564-5720
Fax Number	:	843-899-4970

Authorized Official
Title or Position	:	MANAGER
Name	:	SHERRY PARSONS
Credential	:
Telephone Number	:	843-761-5255

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	04/17/2025

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Directions to “DELTA OF HOLLYWOOD LLC ” Practice Location

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