1538558390 NPI number — CHARLESTON RX LLC

Table of content: (NPI 1538558390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538558390 NPI number — CHARLESTON RX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLESTON RX LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538558390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2498 N PLEASANTBURG DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29609-2730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-236-4350
Provider Business Practice Location Address Fax Number:
864-236-4360
Provider Enumeration Date:
01/16/2015

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  15922 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2163902 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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