Provider Demographics
NPI:1235576711
Name:CHARLESTON ENT ASSOCIATES LLC
Entity Type:Organization
Organization Name:CHARLESTON ENT ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VECCHIOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-793-6402
Mailing Address - Street 1:2295 HENRY TECKLENBURG DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-7801
Mailing Address - Country:US
Mailing Address - Phone:843-793-6402
Mailing Address - Fax:
Practice Address - Street 1:3510 N HIGHWAY 17
Practice Address - Street 2:135
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8227
Practice Address - Country:US
Practice Address - Phone:843-654-7494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site