Provider Demographics
NPI:1790808368
Name:PALMETTO BREATHING SOLUTIONS
Entity Type:Organization
Organization Name:PALMETTO BREATHING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-393-1001
Mailing Address - Street 1:18 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-3212
Mailing Address - Country:US
Mailing Address - Phone:843-393-1001
Mailing Address - Fax:
Practice Address - Street 1:18 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-3212
Practice Address - Country:US
Practice Address - Phone:843-393-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2325Medicaid
SC4309340001Medicare ID - Type UnspecifiedPHARMACY