# SPECIALTY PHARMACY MYRTLE BEACH LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Specialty Pharmacy Myrtle Beach
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033423348
- **Authorized official:** BILLY WEASE (OWNER)
- **Authorized official phone:** (704) 913-7450

## Contact information

- **Practice address:** 5900 N KINGS HWY STE C, MYRTLE BEACH, SC 29577-2326
- **Practice address phone:** (843) 712-1703
- **Practice address fax:** (843) 712-1705
- **Mailing address:** 5900 N KINGS HWY STE C, MYRTLE BEACH, SC 29577-2326
- **Mailing address phone:** (843) 712-1703
- **Mailing address fax:** (843) 712-1705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 11125 | SC | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/28/2010
- **Last updated:** 10/01/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4229781 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |