Healthcare Provider Details

I. General information

NPI: 1629372099
Provider Name (Legal Business Name): MICHAEL EDWARD CAUTHEN R. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 KENSINGTON DR
WAXHAW NC
28173-0103
US

IV. Provider business mailing address

1312 SOMERSET DR
LANCASTER SC
29720-1719
US

V. Phone/Fax

Practice location:
  • Phone: 704-843-7131
  • Fax:
Mailing address:
  • Phone: 803-285-1227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12471
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4639
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: