Organization
ELLOREE PHARMACY LLC
Active
Other names
Elloree Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
VAN WILLIS HIGH II (OWNER)
(843) 761-5255
Entity
Organization
Contact information
Practice address
2611 CLEVELAND STREET, ELLOREE, SC 29047
(803) 897-2131
(803) 897-1129
Mailing address
402 EAST MAIN STREET, MONCKS CORNER, SC 29461
(843) 761-5255
(843) 899-4970
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
50007762
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DME276
—
SC
Enumeration date
04/21/2006
Last updated
10/17/2024
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