Provider Demographics
NPI:1407431109
Name:SODA CITY PHARMACY & COMPOUNDING LLC
Entity Type:Organization
Organization Name:SODA CITY PHARMACY & COMPOUNDING LLC
Other - Org Name:SODA CITY PHARMACY & COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREMAIN
Authorized Official - Middle Name:ODELL
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-766-2015
Mailing Address - Street 1:380 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4427
Mailing Address - Country:US
Mailing Address - Phone:803-766-2015
Mailing Address - Fax:803-563-5135
Practice Address - Street 1:380 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4427
Practice Address - Country:US
Practice Address - Phone:803-766-2015
Practice Address - Fax:803-563-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-14
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy