Organization
SELF REGIONAL HEALTHCARE
Active
Other names
Self Regional Healthcare Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW T LOGAN MD (PRESIDENT AND CEO)
(864) 725-4253
Entity
Organization
Contact information
Practice address
1325 SPRING ST, GREENWOOD, SC 29646-3860
(864) 725-2768
(864) 725-5768
Mailing address
1325 SPRING ST, OUT PATIENT PHARMACY, GREENWOOD, SC 29646-3860
(864) 725-4178
(864) 725-4102
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
15929
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2088425
PK
—
05
—
746553
—
SC
Enumeration date
10/09/2007
Last updated
12/14/2021
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