# SELF REGIONAL HEALTHCARE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Self Regional Healthcare Outpatient Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316135999
- **Authorized official:** DR. MATTHEW T LOGAN MD (PRESIDENT AND CEO)
- **Authorized official phone:** (864) 725-4253

## Contact information

- **Practice address:** 1325 SPRING ST, GREENWOOD, SC 29646-3860
- **Practice address phone:** (864) 725-2768
- **Practice address fax:** (864) 725-5768
- **Mailing address:** 1325 SPRING ST, OUT PATIENT PHARMACY, GREENWOOD, SC 29646-3860
- **Mailing address phone:** (864) 725-4178
- **Mailing address fax:** (864) 725-4102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 15929 | SC | Yes |

## Other

- **Enumeration date:** 10/09/2007
- **Last updated:** 12/14/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2088425 | PK | — |
| 05 | — | 746553 | — | SC |