Provider Demographics
NPI:1366806077
Name:WALHALLA PHARMACY LLC
Entity type:Organization
Organization Name:WALHALLA PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ELAFFY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, CGP
Authorized Official - Phone:864-916-0680
Mailing Address - Street 1:206 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:SC
Mailing Address - Zip Code:29691-1927
Mailing Address - Country:US
Mailing Address - Phone:864-916-0680
Mailing Address - Fax:864-916-0681
Practice Address - Street 1:206 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:SC
Practice Address - Zip Code:29691-1927
Practice Address - Country:US
Practice Address - Phone:864-916-0680
Practice Address - Fax:864-916-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC158493336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy