Healthcare Provider Details

I. General information

NPI: 1285546317
Provider Name (Legal Business Name): JOSE ANGELO MERCADO ANTONIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BROAD ST
CAMDEN SC
29020-2225
US

IV. Provider business mailing address

2500 BROAD ST
CAMDEN SC
29020-2225
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-5103
  • Fax:
Mailing address:
  • Phone: 803-432-5103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67998
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: