Provider Demographics
NPI:1336506427
Name:CARESOUTH CAROLINA INC
Entity Type:Organization
Organization Name:CARESOUTH CAROLINA INC
Other - Org Name:CSC COMMUNITY PHARMACY-LATTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-857-0111
Mailing Address - Street 1:122 LATIMER ST
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-1828
Mailing Address - Country:US
Mailing Address - Phone:843-627-6261
Mailing Address - Fax:843-627-6265
Practice Address - Street 1:122 LATIMER ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1828
Practice Address - Country:US
Practice Address - Phone:843-627-6261
Practice Address - Fax:843-627-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC162973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157481OtherPK
SC716297Medicaid