Organization
SOVEREIGN MEDICAL CONSULTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD EDMOND GRACE PHARM.D. (PRESIDENT)
(864) 451-4250
Entity
Organization
Contact information
Practice address
15 VILLA RD, APT #182, GREENVILLE, SC 29615
(864) 451-4250
Mailing address
15 VILLA RD, APT #182, GREENVILLE, SC 29615
(864) 451-4250
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
308009535
DC
305S00000X
Point of Service
Primary
101491182
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101491182
SC DEPARTMENT OF REVENUE
SC
Enumeration date
04/11/2018
Last updated
04/11/2018
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