Provider Demographics
NPI:1134731649
Name:SELECT CARE PHARMACY, LLC.
Entity type:Organization
Organization Name:SELECT CARE PHARMACY, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-471-2510
Mailing Address - Street 1:480 JESSEN LN STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7915
Mailing Address - Country:US
Mailing Address - Phone:843-471-2510
Mailing Address - Fax:866-530-0413
Practice Address - Street 1:480 JESSEN LN STE A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-7915
Practice Address - Country:US
Practice Address - Phone:843-471-2510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7Z1112Medicaid