MEDICARE: SWEETGRASS PHARMACY & COMPOUNDING 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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1700426723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWEETGRASS PHARMACY & COMPOUNDING LLC

Provider Business Mailing Address
First Line	:	1952 LONG GROVE DR STE 1
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-7579
Country	:	US
Telephone Number	:	843-654-4013
Fax Number	:

Provider Business Practice Location Address
First Line	:	1952 LONG GROVE DR STE 1
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-7579
Country	:	US
Telephone Number	:	843-654-4013
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	CYNTHIA FELDMAN
Credential	:	PHARMD
Telephone Number	:	843-654-4013

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	11/27/2023

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