Provider Demographics
NPI:1275545667
Name:THOMSON STUDENT HEALTH CENTER PHARMACY
Entity Type:Organization
Organization Name:THOMSON STUDENT HEALTH CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-777-3957
Mailing Address - Street 1:UNIVERSITY OF SOUTH CAROLINA
Mailing Address - Street 2:1409 DEVINE STREET
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29208-0001
Mailing Address - Country:US
Mailing Address - Phone:803-777-4890
Mailing Address - Fax:803-777-0965
Practice Address - Street 1:UNIVERSITY OF SOUTH CAROLINA
Practice Address - Street 2:1409 DEVINE STREET
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:803-777-4890
Practice Address - Fax:803-777-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50000829261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4208636OtherNABP NUMBER