MEDICARE: DARLENE LAWSON VANCLEAVE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	4069	SC

General Provider Information

NPI Number	:	1184930703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLENE LAWSON VANCLEAVE PHARMD

Provider Business Mailing Address
First Line	:	7900 GARNERS FERRY RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-4738
Country	:	US
Telephone Number	:	803-695-1116
Fax Number	:	803-695-1119

Provider Business Practice Location Address
First Line	:	7900 GARNERS FERRY RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-4738
Country	:	US
Telephone Number	:	803-695-1116
Fax Number	:	803-695-1119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2010
Last Update Date	:	08/19/2010

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Directions to “ DARLENE LAWSON VANCLEAVE PHARMD” Practice Location

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