Provider Demographics
NPI:1902005135
Name:S.C. DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Entity Type:Organization
Organization Name:S.C. DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Other - Org Name:DHEC REGION 4 HEALTH DISTRICT PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SOJOURNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-898-0813
Mailing Address - Street 1:1751 CALHOUN ST
Mailing Address - Street 2:PO BOX 101106
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2606
Mailing Address - Country:US
Mailing Address - Phone:803-898-0813
Mailing Address - Fax:803-898-0557
Practice Address - Street 1:145 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2526
Practice Address - Country:US
Practice Address - Phone:843-661-4830
Practice Address - Fax:843-661-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50009578333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC795781Medicaid