Provider Demographics
NPI:1134720535
Name:DETYENS MEDICAL CENTER
Entity type:Organization
Organization Name:DETYENS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-747-3284
Mailing Address - Street 1:1670 DRYDOCK AVENUE
Mailing Address - Street 2:BUILDING 10, SUITE A
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405
Mailing Address - Country:US
Mailing Address - Phone:843-747-3284
Mailing Address - Fax:843-308-6570
Practice Address - Street 1:1670 DRYDOCK AVENUE
Practice Address - Street 2:BUILDING 10, SUITE A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405
Practice Address - Country:US
Practice Address - Phone:843-747-3284
Practice Address - Fax:843-308-6570
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DETYENS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy