Provider Demographics
NPI:1780217208
Name:CROCODILE PHARMACY SERVICES, LLC
Entity Type:Organization
Organization Name:CROCODILE PHARMACY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-730-1500
Mailing Address - Street 1:9005 TWO NOTCH RD
Mailing Address - Street 2:STE 40
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5850
Mailing Address - Country:US
Mailing Address - Phone:480-235-7788
Mailing Address - Fax:
Practice Address - Street 1:738 UNIVERSITY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7611
Practice Address - Country:US
Practice Address - Phone:480-235-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROCODILE PHARMACY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty