Provider Demographics
NPI:1952699688
Name:HOPE CLINIC
Entity type:Organization
Organization Name:HOPE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TEMISAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ETIKEVENTSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-725-1225
Mailing Address - Street 1:110 EXECUTIVE PKWY
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3930
Mailing Address - Country:US
Mailing Address - Phone:843-725-1225
Mailing Address - Fax:888-318-5567
Practice Address - Street 1:110 EXECUTIVE PKWY
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3930
Practice Address - Country:US
Practice Address - Phone:843-725-1225
Practice Address - Fax:888-318-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No332900000XSuppliersNon-Pharmacy Dispensing Site