MEDICARE: THERESA KRAFNICK DYCHES 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	8488	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457462624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA KRAFNICK DYCHES RPH

Provider Business Mailing Address
First Line	:	PO BOX 129
Second Line	:
City	:	WAGENER
State	:	SC
Zip	:	29164-0129
Country	:	US
Telephone Number	:	803-564-5381
Fax Number	:	803-564-5398

Provider Business Practice Location Address
First Line	:	129 NORTH MAIN ST
Second Line	:
City	:	WAGENER
State	:	SC
Zip	:	29164-0129
Country	:	US
Telephone Number	:	803-564-5381
Fax Number	:	803-564-5398

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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