Provider Demographics
NPI:1952471211
Name:PALMETTO HEALTH ALLIANCE
Entity Type:Organization
Organization Name:PALMETTO HEALTH ALLIANCE
Other - Org Name:PALMETTO HEALTH PHARMACY PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-931-8124
Mailing Address - Street 1:1308 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2514
Mailing Address - Country:US
Mailing Address - Phone:803-931-8123
Mailing Address - Fax:803-931-8201
Practice Address - Street 1:1308 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2514
Practice Address - Country:US
Practice Address - Phone:803-931-8123
Practice Address - Fax:803-931-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC138213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4228171OtherNCPDP PROVIDER IDENTIFICATION NUMBER