Provider Demographics
NPI:1659470433
Name:MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Other - Org Name:RUTLEDGE TOWER 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 AVENUE, 6TH FLOOR
Mailing Address - Street 2:MSC 584
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425
Mailing Address - Country:US
Mailing Address - Phone:843-792-5691
Mailing Address - Fax:843-792-2360
Practice Address - Street 1:135 RUTLEDGE ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8903
Practice Address - Country:US
Practice Address - Phone:843-876-0253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4404333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC744042Medicaid
SCDME802Medicaid
SC744042Medicaid