Provider Demographics
NPI:1821186461
Name:BLACKVILLE HEALTH INVESTORS
Entity Type:Organization
Organization Name:BLACKVILLE HEALTH INVESTORS
Other - Org Name:DANIELS PHARMACY OF BLACKVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:803-284-3372
Mailing Address - Street 1:19354 SOLOMON BLATT AVE N
Mailing Address - Street 2:
Mailing Address - City:BLACKVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29817-2304
Mailing Address - Country:US
Mailing Address - Phone:803-284-3372
Mailing Address - Fax:803-284-3372
Practice Address - Street 1:19354 SOLOMON BLATT AVE N
Practice Address - Street 2:
Practice Address - City:BLACKVILLE
Practice Address - State:SC
Practice Address - Zip Code:29817-2304
Practice Address - Country:US
Practice Address - Phone:803-284-3372
Practice Address - Fax:803-284-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC143283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1821186461Medicaid
4211164OtherNCPDP PROVIDER IDENTIFICATION NUMBER