Provider Demographics
NPI:1093987091
Name:CLARENDON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CLARENDON MEMORIAL HOSPITAL
Other - Org Name:CYPRESS CENTER LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-435-8463
Mailing Address - Street 1:50 E HOSPITAL ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3149
Mailing Address - Country:US
Mailing Address - Phone:803-435-5272
Mailing Address - Fax:803-435-5271
Practice Address - Street 1:50 E HOSPITAL ST STE 1
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3149
Practice Address - Country:US
Practice Address - Phone:803-435-5272
Practice Address - Fax:803-435-5271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARENDON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500098733336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy