MEDICARE: DR. CASEY CUSHMAN

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	12653	SC

General Provider Information

NPI Number	:	1437400553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASEY CUSHMAN

Provider Business Mailing Address
First Line	:	454 BERRYHILL RD
Second Line	:	SUITE A
City	:	COLUMBIA
State	:	SC
Zip	:	29210-6447
Country	:	US
Telephone Number	:	803-217-1088
Fax Number	:

Provider Business Practice Location Address
First Line	:	454 BERRYHILL RD
Second Line	:	SUITE A
City	:	COLUMBIA
State	:	SC
Zip	:	29210-6447
Country	:	US
Telephone Number	:	803-217-1088
Fax Number	:

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

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	09/28/2012

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Directions to “ DR. CASEY CUSHMAN ” Practice Location

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