MEDICARE: MISS SARAH RACHEL VICTORIA DEPTULA 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	35426	SC

General Provider Information

NPI Number	:	1811270184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SARAH RACHEL VICTORIA DEPTULA PHARMD

Provider Business Mailing Address
First Line	:	2222 MAXCY ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2715
Country	:	US
Telephone Number	:	843-637-1891
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 FOLLY RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3919
Country	:	US
Telephone Number	:	843-795-5452
Fax Number	:

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

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	03/03/2014

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