Healthcare Provider Details

I. General information

NPI: 1104970474
Provider Name (Legal Business Name): MCLESKEY-TODD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 23RD ST
GREER SC
29651-3848
US

IV. Provider business mailing address

12 23RD ST
GREER SC
29651-3848
US

V. Phone/Fax

Practice location:
  • Phone: 864-877-0847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number12210
License Number StateSC

VIII. Authorized Official

Name: JOHN ALLEN
Title or Position: PIC
Credential:
Phone: 864-877-0753