Organization
OCEAN LAKES PHARMACY INC
Active
Other names
OCEAN LAKES PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER WILLIAMS (OWNER)
(848) 238-5159
Entity
Organization
Contact information
Practice address
1415 HWY 17 BUSINESS N, SURFSIDE BEACH, SC 29575
(843) 238-5159
(843) 238-8270
Mailing address
1415 HWY 17 BUSINESS N, SURFSIDE BEACH, SC 29575
(843) 238-5159
(843) 238-8270
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
50004721
SC
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2088907
PK
—
05
—
611804
—
SC
05
—
747216
—
SC
05
—
EN2106
—
SC
Enumeration date
10/23/2006
Last updated
02/28/2017
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