Provider Demographics
NPI:1497039390
Name:MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Other - Org Name:MUSC- MAIL ORDER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-792-8775
Mailing Address - Street 1:150 ASHLEY AVE
Mailing Address - Street 2:ROOM 618
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8907
Mailing Address - Country:US
Mailing Address - Phone:843-792-5691
Mailing Address - Fax:843-792-2360
Practice Address - Street 1:7771 PALMETTO COMMERCE PKWY RM 404
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-8825
Practice Address - Country:US
Practice Address - Phone:843-792-2866
Practice Address - Fax:843-985-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC134973336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC713497Medicaid
SC713497Medicaid