Provider Demographics
NPI:1386172294
Name:BLUE HERON ACUPUNCTURE AND APOTHECARY, LLC
Entity type:Organization
Organization Name:BLUE HERON ACUPUNCTURE AND APOTHECARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:RHODES MCBRIDE
Authorized Official - Last Name:ABERNATHY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MS
Authorized Official - Phone:843-937-6890
Mailing Address - Street 1:711 SAINT ANDREWS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7196
Mailing Address - Country:US
Mailing Address - Phone:843-937-6890
Mailing Address - Fax:
Practice Address - Street 1:711 SAINT ANDREWS BLVD STE A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-937-6890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty