Healthcare Provider Details

I. General information

NPI: 1205823309
Provider Name (Legal Business Name): MCLEOD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N MAIN ST
BISHOPVILLE SC
29010-1413
US

IV. Provider business mailing address

127 N MAIN ST
BISHOPVILLE SC
29010-1413
US

V. Phone/Fax

Practice location:
  • Phone: 803-484-6115
  • Fax: 803-484-4128
Mailing address:
  • Phone: 803-484-6115
  • Fax: 803-484-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8364
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number20160142
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number8364
License Number StateSC

VIII. Authorized Official

Name: DAVID ROBERSON
Title or Position: RPH
Credential: RPH
Phone: 803-484-6115