Provider Demographics
NPI:1760620108
Name:PALMETTO CUSTOM COMPOUNDING
Entity Type:Organization
Organization Name:PALMETTO CUSTOM COMPOUNDING
Other - Org Name:PRESCRIPTION CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:MEL
Authorized Official - Last Name:RAUTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-723-5343
Mailing Address - Street 1:107 RUTLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1332
Mailing Address - Country:US
Mailing Address - Phone:843-723-5343
Mailing Address - Fax:843-723-5344
Practice Address - Street 1:107 RUTLEDGE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1332
Practice Address - Country:US
Practice Address - Phone:843-723-5343
Practice Address - Fax:843-723-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5010268OtherPHARMACY PERMIT