# ELLOREE PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Elloree Pharmacy, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912963745
- **Authorized official:** VAN WILLIS HIGH II (OWNER)
- **Authorized official phone:** (843) 761-5255

## Contact information

- **Practice address:** 2611 CLEVELAND STREET, ELLOREE, SC 29047
- **Practice address phone:** (803) 897-2131
- **Practice address fax:** (803) 897-1129
- **Mailing address:** 402 EAST MAIN STREET, MONCKS CORNER, SC 29461
- **Mailing address phone:** (843) 761-5255
- **Mailing address fax:** (843) 899-4970

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 50007762 | SC | Yes |

## Other

- **Enumeration date:** 04/21/2006
- **Last updated:** 10/17/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | DME276 | — | SC |