MEDICARE: EAST COOPER FAMILY PHARMACY

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	332B00000X	Durable Medical Equipment & Medical Supplies	50002348	SC
2	333600000X	Pharmacy	50002348	SC

General Provider Information

NPI Number	:	1366502007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST COOPER FAMILY PHARMACY

Provider Business Mailing Address
First Line	:	913 BOWMAN RD
Second Line	:	SUITE 100
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3235
Country	:	US
Telephone Number	:	843-881-0478
Fax Number	:	843-881-5532

Provider Business Practice Location Address
First Line	:	913 BOWMAN RD
Second Line	:	SUITE 100
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3235
Country	:	US
Telephone Number	:	843-881-0478
Fax Number	:	843-881-5532

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MARY ANNE CISA
Credential	:
Telephone Number	:	843-881-0478

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	10/24/2014

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Directions to “EAST COOPER FAMILY PHARMACY ” Practice Location

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