Provider Demographics
NPI:1538558390
Name:CHARLESTON RX LLC
Entity type:Organization
Organization Name:CHARLESTON RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-212-2967
Mailing Address - Street 1:2498 N PLEASANTBURG DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-2730
Mailing Address - Country:US
Mailing Address - Phone:843-212-2967
Mailing Address - Fax:864-752-2253
Practice Address - Street 1:2498 N PLEASANTBURG DR
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-2730
Practice Address - Country:US
Practice Address - Phone:864-236-4350
Practice Address - Fax:864-236-4360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC159223336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163902OtherPK