Organization · Type 2 NPI

Evernorth Direct Health LLC

Non-Pharmacy Dispensing Site · Bennettsville, SC

NPI number 1730440769 Active

Practice location

2094 Marlboro Rd
Bennettsville, SC 29512

Call (843) 528-3696 Map

Mailing address

5626 Oberlin Dr, Suite 110
San Diego, CA 92121-1705

Specialties and licenses

Taxonomy	Code	License
Non-Pharmacy Dispensing Site Primary	332900000X	RN3361 (SC)

Non-Pharmacy Dispensing Site: A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

NPI record

NPI: 1730440769
Entity type: Organization (Type 2)
Issued: Jun 6, 2012
Last updated: May 3, 2021
Status: Active
Subpart: Yes of Medvantx Inc

Other names

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Mohawk Healthy Life Center - Oak River SC · doing business as
Mohawk Healthy Life Center - Oak River SC · doing business as

Authorized official

Kenny Heine
VP of Operations
(858) 964-1506

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1730440769

Evernorth Direct Health LLC's National Provider Identifier is 1730440769, issued on Jun 6, 2012. The primary taxonomy on file is Non-Pharmacy Dispensing Site (332900000X), and the practice location is in Bennettsville, SC. The record was last updated on May 3, 2021.