Provider Demographics
NPI:1285527796
Name:SWEETGRASS PHARMACY CAROLINA PARK, LLC
Entity type:Organization
Organization Name:SWEETGRASS PHARMACY CAROLINA PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:843-800-7007
Mailing Address - Street 1:3485 PARK AVENUE BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7242
Mailing Address - Country:US
Mailing Address - Phone:843-800-7007
Mailing Address - Fax:
Practice Address - Street 1:3485 PARK AVENUE BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7242
Practice Address - Country:US
Practice Address - Phone:843-800-7007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWEETGRASS PHARMACY CAROLINA PARK, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy