Provider Demographics
NPI:1336448166
Name:BOYD, CHARLES EDWIN JR
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EDWIN
Last Name:BOYD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-5739
Mailing Address - Country:US
Mailing Address - Phone:843-332-4523
Mailing Address - Fax:843-332-6701
Practice Address - Street 1:901 S 5TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5739
Practice Address - Country:US
Practice Address - Phone:843-332-4523
Practice Address - Fax:843-332-6701
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist