MEDICARE: LAKE MURRAY HEALTH AND WELLNESS, 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

General Provider Information

NPI Number	:	1720668577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE MURRAY HEALTH AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	2 PALMETTO WOOD PKWY STE 100
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2956
Country	:	US
Telephone Number	:	803-212-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 PALMETTO WOOD PKWY STE 100
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2956
Country	:	US
Telephone Number	:	803-212-9999
Fax Number	:	803-769-3232

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	DR. JUSTIN CARTER
Credential	:	PHARM.D.
Telephone Number	:	803-212-9999

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	04/14/2021

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