Provider Demographics
NPI:1245754746
Name:TRUAX, L. DEXTER SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:L.
Middle Name:DEXTER
Last Name:TRUAX
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1018
Mailing Address - Street 2:
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-1018
Mailing Address - Country:US
Mailing Address - Phone:912-777-4847
Mailing Address - Fax:
Practice Address - Street 1:350 ROBERT SMALLS PKWY
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-4284
Practice Address - Country:US
Practice Address - Phone:843-522-8221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPH5863183500000X, 333600000X, 3336C0003X
GARPH0171833336C0003X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPH5863OtherBOARD OF PHAMRACY
GARPH017183OtherBOARD OF PHARMACY