MEDICARE: MARK VANOURNY RPH

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	12817	SC

General Provider Information

NPI Number	:	1356759161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK VANOURNY RPH

Provider Business Mailing Address
First Line	:	161 BLACK MOUNTAIN DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6505
Country	:	US
Telephone Number	:	319-360-7007
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 BLACK MOUNTAIN DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6505
Country	:	US
Telephone Number	:	319-360-7007
Fax Number	:

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

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	07/24/2014

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