1588704894 NPI number — DANIEL ISLAND PHARMACY, LLC

Table of content: (NPI 1588704894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588704894 NPI number — DANIEL ISLAND PHARMACY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL ISLAND PHARMACY, 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:
1588704894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
162 SEVEN FARMS DR
Provider Second Line Business Mailing Address:
SUITE 330
Provider Business Mailing Address City Name:
DANIEL ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29492-8026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-971-3992
Provider Business Mailing Address Fax Number:
843-971-6045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
162 SEVEN FARMS DR
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
DANIEL ISLAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29492-8026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-971-3992
Provider Business Practice Location Address Fax Number:
843-971-6045
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
DANA
Authorized Official Middle Name:
WRIGHT
Authorized Official Title or Position:
PHARMAIST IN CHARGE OWNER
Authorized Official Telephone Number:
843-971-3992

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  50007758 , 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: 4225404 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 777587 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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