42D0710920 CLIA NUMBER - MUSC HEALTH INTERNAL MEDICINE - ORANGEBURG

Laboratory Demographics

CLIA Number: 42D0710920

Facility Name: MUSC HEALTH INTERNAL MEDICINE - ORANGEBURG

Facility Address:
1097A COOK ROAD
ORANGEBURG, SC
ZIP 29118
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Facility Phone Number: 803 534-5110

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1952632234

Taxonomy: 3336C0002X - Pharmacy
A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.

CLIA Record

Field Name	Field Value
CLIA Number	42D0710920
LAB Type	Physician Office
Facility Name	MUSC HEALTH INTERNAL MEDICINE - ORANGEBURG
Street	1097A COOK ROAD
City	ORANGEBURG
State	SC
ZIP	29118
Phone	803 534-5110
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024