Provider Demographics
NPI:1659511061
Name:MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Other - Org Name:MUSC HOLLINGS CANCER CENTER 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:MSC 584
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8907
Mailing Address - Country:US
Mailing Address - Phone:843-792-1009
Mailing Address - Fax:843-792-2360
Practice Address - Street 1:86 JONATHAN LUCAS ST RM 114
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8900
Practice Address - Country:US
Practice Address - Phone:843-876-0199
Practice Address - Fax:843-792-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
SC31023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC731027Medicaid
2091573OtherPK
2091573OtherPK