Provider Demographics
NPI:1730669789
Name:EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Other - Org Name:EASTOVER COOPERATIVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DELGADO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-733-5969
Mailing Address - Street 1:169 LAURELHURST AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-3825
Mailing Address - Country:US
Mailing Address - Phone:803-733-5969
Mailing Address - Fax:
Practice Address - Street 1:3041 OLD EASTOVER ROAD
Practice Address - Street 2:
Practice Address - City:EASTOVER
Practice Address - State:SC
Practice Address - Zip Code:29044
Practice Address - Country:US
Practice Address - Phone:803-875-8010
Practice Address - Fax:803-875-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy