Provider Demographics
NPI:1912191305
Name:CHOICE PHARMACY AT CELIA SAXON LLC
Entity Type:Organization
Organization Name:CHOICE PHARMACY AT CELIA SAXON LLC
Other - Org Name:CHOICECARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-361-7706
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:EASTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40018-0063
Mailing Address - Country:US
Mailing Address - Phone:803-361-0788
Mailing Address - Fax:803-931-3290
Practice Address - Street 1:2012 HARDEN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-0915
Practice Address - Country:US
Practice Address - Phone:803-931-3200
Practice Address - Fax:803-931-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500096063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4227179OtherNCPDP PROVIDER IDENTIFICATION NUMBER