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Organization
BERKELEY HOME PHARMACY LLC
Active
Organization
BERKELEY HOME PHARMACY LLC
Active
Other names
Berkeley Home Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TED TRISTAN NUSSBAUM RPH (OWNER/PHARMACIST)
(843) 899-4700
Entity
Organization
Contact information
Practice address
1008 OLD HIGHWAY 52 STE G, MONCKS CORNER, SC 29461-3011
(843) 899-4700
(843) 899-4702
Mailing address
1008 OLD HIGHWAY 52 STE G, MONCKS CORNER, SC 29461-3011
(843) 899-4700
(843) 899-4702
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
16354
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2157670
PK
—
05
—
716354
—
SC
Enumeration date
01/20/2016
Last updated
06/10/2025
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