Dermatology and Laser Center of Charleston/Palmetto State Pharm

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

19977 Issued in SC

Legal business name

DERMATOLOGY AND LASER CENTER OF CHARLESTON/PALMETTO STATE PHARM

Doing business as

Primary Rx

Practice address

2093 Henry Tecklenburg Dr
Suite 300
Charleston, SC 29414-5741

Phone

(843) 556-8886

Fax

(888) 318-5567

NPI assigned

Mar 1, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Knapp

Title

Credentialing Specialist

Phone

(843) 408-4171

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Primary Rx Doing business as

Tax ID family

Dermatology and Laser Center of Charlestonpalmetto State Pharm2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Palmetto State Pharmaceuticals Inc

  dba PrimaryRx

  • Mail Order Pharmacy
  • Charleston, SC
  • NPI 1639276561
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267574400000",
    "number": "1508189838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 SAM RITTENBERG BLVD",
            "address_2": "SUITE 3009",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294074629",
            "telephone_number": "843-769-7633",
            "fax_number": "888-318-5567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2093 HENRY TECKLENBURG DR",
            "address_2": "SUITE 300",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145741",
            "telephone_number": "843-556-8886",
            "fax_number": "888-318-5567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AND LASER CENTER OF CHARLESTON/PALMETTO STATE PHARM",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-01",
        "last_updated": "2010-03-03",
        "status": "A",
        "authorized_official_last_name": "KNAPP",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "843-408-4171"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "SC",
            "license": "19977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE TYPE UNSPECIFIED",
            "identifier": "8276",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Rx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ian Depew, MD
• Christopher James Depietro, DO
• Brittany Paige Depriest, M.D.
• Sarah Rachel Victoria Deptula, PHARMD
• Dermatology and Laser Center of Charleston PA
• Dermhaus
• Sydney Derrick, MD
• Anushri Vijay Desai, MD
• Nimit Nitin Desai, MD
• Jenny Lee Desart, CRNA

• Dermatology Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Dermatology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.