MEDICARE: PHOENIX PHARMACY 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	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1487523221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX PHARMACY LLC

Provider Business Mailing Address
First Line	:	1204 HOSPITAL DRIVE
Second Line	:	SUITE 102
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464
Country	:	US
Telephone Number	:	854-238-4499
Fax Number	:	854-238-4477

Provider Business Practice Location Address
First Line	:	1204 HOSPITAL DRIVE
Second Line	:	SUITE 102
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464
Country	:	US
Telephone Number	:	854-238-4499
Fax Number	:	854-238-4477

Authorized Official
Title or Position	:	OWNER
Name	:	CHAD STRAUGHAN
Credential	:	PHARMD
Telephone Number	:	854-238-4499

Provider Enumeration Date	:	10/31/2025
Last Update Date	:	01/26/2026

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