Provider Demographics
NPI:1174734198
Name:ATLANTIC PHARMACY SERVICES
Entity type:Organization
Organization Name:ATLANTIC PHARMACY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-554-4000
Mailing Address - Street 1:2090 EXECUTIVE HALL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-8709
Mailing Address - Country:US
Mailing Address - Phone:843-554-4000
Mailing Address - Fax:843-769-6849
Practice Address - Street 1:2090 EXECUTIVE HALL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-8709
Practice Address - Country:US
Practice Address - Phone:843-554-4000
Practice Address - Fax:843-769-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500036653336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4221470OtherNCPDP
SC736656Medicaid
SC736656Medicaid