Healthcare Provider Details

I. General information

NPI: 1144755539
Provider Name (Legal Business Name): KRISTINA VIZCAINO PHARMD, CACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR STE C300
GREENVILLE SC
29615-6324
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-2852
  • Fax:
Mailing address:
  • Phone: 864-522-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number36847
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24981
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number24981
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36847
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: