Provider Demographics
NPI:1366502007
Name:EAST COOPER FAMILY PHARMACY
Entity Type:Organization
Organization Name:EAST COOPER FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-881-0478
Mailing Address - Street 1:913 BOWMAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3235
Mailing Address - Country:US
Mailing Address - Phone:843-881-0478
Mailing Address - Fax:843-881-5532
Practice Address - Street 1:913 BOWMAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3235
Practice Address - Country:US
Practice Address - Phone:843-881-0478
Practice Address - Fax:843-881-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50002348332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0360790001Medicare ID - Type Unspecified