Provider Demographics
NPI:1477542694
Name:CYPRESS CENTER PHARMACY
Entity Type:Organization
Organization Name:CYPRESS CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHADWICK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-435-5224
Mailing Address - Street 1:50 HOSPITAL STREET
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-0550
Mailing Address - Country:US
Mailing Address - Phone:803-435-5224
Mailing Address - Fax:
Practice Address - Street 1:50 HOSPITAL STREET
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-0550
Practice Address - Country:US
Practice Address - Phone:803-435-5224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50005730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty