Organization
PALMETTO SPECIALTY PHARM LLC
Active
Other names
Palmetto Pharm
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN JOSEPH FENNICK PHARMD (CEO)
(724) 683-6779
Entity
Organization
Contact information
Practice address
1200 TWO ISLAND CT UNIT B, MOUNT PLEASANT, SC 29466-7418
(843) 972-7704
(843) 972-9395
Mailing address
1200 TWO ISLAND CT UNIT B, MOUNT PLEASANT, SC 29466-7418
(843) 972-7704
(843) 972-9395
Taxonomy
Speciality
Code
Description
License number
State
3336M0002X
Mail Order Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20906
SOUTH CAROLINA STATE PHARMACY LICENSE
SC
Enumeration date
10/26/2022
Last updated
10/26/2022
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