Provider Demographics
NPI:1205972098
Name:HOGUE, SAMUEL C (RPH)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:C
Last Name:HOGUE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LAUREL CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-9194
Mailing Address - Country:US
Mailing Address - Phone:803-438-5935
Mailing Address - Fax:
Practice Address - Street 1:7451 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2602
Practice Address - Country:US
Practice Address - Phone:803-695-1710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8415OtherSTATE PHARMACY LICENSE