Provider Demographics
NPI:1295289742
Name:WATERWAY PHARMACY LLC
Entity type:Organization
Organization Name:WATERWAY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MOHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MS PHARMACOLOGY
Authorized Official - Phone:843-734-0612
Mailing Address - Street 1:3373 HIGHWAY 9 E
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-7826
Mailing Address - Country:US
Mailing Address - Phone:843-734-0612
Mailing Address - Fax:843-734-0793
Practice Address - Street 1:3373 HIGHWAY 9 E
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7826
Practice Address - Country:US
Practice Address - Phone:843-734-0612
Practice Address - Fax:843-734-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC167933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC716793Medicaid
2162521OtherPK