Organization
BERKELEY HOME PHARMACY LLC
Active
Other names
Berkeley Home Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TED TRISTAN NUSSBAUM RPH (OWNER/PHARMACIST)
(843) 899-4700
Entity
Organization
Contact information
Practice address
1008 OLD HIGHWAY 52 STE G, MONCKS CORNER, SC 29461-3011
(843) 899-4700
(843) 899-4702
Mailing address
1008 OLD HIGHWAY 52 STE G, MONCKS CORNER, SC 29461-3011
(843) 899-4700
(843) 899-4702
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
16354
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2157670
PK
—
05
—
716354
—
SC
Enumeration date
01/20/2016
Last updated
06/10/2025
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