Organization
DERMATOLOGY AND LASER CENTER OF CHARLESTON/PALMETTO STATE PHARM
Active
Other names
Primary Rx
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER KNAPP (CREDENTIALING SPECIALIST)
(843) 408-4171
Entity
Organization
Contact information
Practice address
2093 HENRY TECKLENBURG DR, SUITE 300, CHARLESTON, SC 29414-5741
(843) 556-8886
(888) 318-5567
Mailing address
2000 SAM RITTENBERG BLVD, SUITE 3009, CHARLESTON, SC 29407-4629
(843) 769-7633
(888) 318-5567
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
19977
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8276
MEDICARE TYPE UNSPECIFIED
SC
Enumeration date
03/01/2010
Last updated
03/03/2010
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