Provider Demographics
NPI:1831567858
Name:DHEC HEMOPHILIA-CSHCN PROGRAM
Entity type:Organization
Organization Name:DHEC HEMOPHILIA-CSHCN PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DHEC - ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:H
Authorized Official - Last Name:GARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-898-3720
Mailing Address - Street 1:PO BOX 101106
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29211-0106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 BULL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2104
Practice Address - Country:US
Practice Address - Phone:803-898-3720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14613333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy