Provider Demographics
NPI:1972998128
Name:WALHALLA PHARMACY LLC
Entity Type:Organization
Organization Name:WALHALLA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ELAFFY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM-D, CGP
Authorized Official - Phone:864-916-0680
Mailing Address - Street 1:21 DOWNS LOOP
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2009
Mailing Address - Country:US
Mailing Address - Phone:864-916-0680
Mailing Address - Fax:
Practice Address - Street 1:206 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:SC
Practice Address - Zip Code:29691-1927
Practice Address - Country:US
Practice Address - Phone:864-916-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-04
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC120693336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy