Provider Demographics
NPI:1275756223
Name:TELLIS PHARMACY INC
Entity Type:Organization
Organization Name:TELLIS PHARMACY INC
Other - Org Name:INDEPENDANT PHARMACY RETAIL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH BS PHARM
Authorized Official - Phone:843-723-0682
Mailing Address - Street 1:125 KING ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-2208
Mailing Address - Country:US
Mailing Address - Phone:843-423-0682
Mailing Address - Fax:
Practice Address - Street 1:125 KING ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-2208
Practice Address - Country:US
Practice Address - Phone:843-723-0682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
01 180790000017OtherSID #
5000 1824OtherPERMIT
5000 1824OtherPERMIT