Provider Demographics
NPI:1124341466
Name:BOYD PHARMACY LLC
Entity type:Organization
Organization Name:BOYD PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-769-7633
Mailing Address - Street 1:2000 SAM RITTENBERG BLVD
Mailing Address - Street 2:SUITE 116B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4629
Mailing Address - Country:US
Mailing Address - Phone:843-769-7633
Mailing Address - Fax:843-769-7693
Practice Address - Street 1:2000 SAM RITTENBERG BLVD
Practice Address - Street 2:SUITE 116B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4629
Practice Address - Country:US
Practice Address - Phone:843-769-7633
Practice Address - Fax:843-769-7693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty