Provider Demographics
NPI:1700426723
Name:SWEETGRASS PHARMACY & COMPOUNDING LLC
Entity Type:Organization
Organization Name:SWEETGRASS PHARMACY & COMPOUNDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:843-654-4013
Mailing Address - Street 1:1952 LONG GROVE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7579
Mailing Address - Country:US
Mailing Address - Phone:843-654-4013
Mailing Address - Fax:
Practice Address - Street 1:1952 LONG GROVE DR STE 1
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7579
Practice Address - Country:US
Practice Address - Phone:843-654-4013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWEETGRASS PHARMACY & COMPOUNDING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy