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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1760266340
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	:	803-769-3232

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
Name	:	JUSTIN PALMER CARTER
Credential	:
Telephone Number	:	803-345-9999

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	08/23/2023

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