Organization
LAKE WYLIE HEALTH INVESTORS INC
Active
Other names
Lake Wylie Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE MCHUGH (PRESIDENT)
(803) 240-9882
Entity
Organization
Contact information
Practice address
221 LATITUDE LN STE 109, LAKE WYLIE, SC 29710-8117
(803) 831-2044
(803) 939-8489
Mailing address
PO BOX 5343, LAKE WYLIE, SC 29710-5004
(803) 831-2044
(803) 939-8389
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
13665
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4230479
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/12/2011
Last updated
01/27/2021
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