MEDICARE: CHARLESTON RX 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	15922	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2163902	OTHER		PK

General Provider Information

NPI Number	:	1538558390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON RX LLC

Provider Business Mailing Address
First Line	:	2498 N PLEASANTBURG DR
Second Line	:	SUITE A
City	:	GREENVILLE
State	:	SC
Zip	:	29609-2730
Country	:	US
Telephone Number	:	843-212-2967
Fax Number	:	864-752-2253

Provider Business Practice Location Address
First Line	:	2498 N PLEASANTBURG DR
Second Line	:	SUITE A
City	:	GREENVILLE
State	:	SC
Zip	:	29609-2730
Country	:	US
Telephone Number	:	864-236-4350
Fax Number	:	864-236-4360

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MICHAEL CALNAN
Credential	:
Telephone Number	:	864-212-2967

Provider Enumeration Date	:	01/16/2015
Last Update Date	:	03/09/2017

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Directions to “CHARLESTON RX LLC ” Practice Location

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