Healthcare Provider Details

I. General information

NPI: 1518022789
Provider Name (Legal Business Name): MEDICAL ARTS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S 2ND ST
HARTSVILLE SC
29550-4304
US

IV. Provider business mailing address

206 S 2ND ST
HARTSVILLE SC
29550-4304
US

V. Phone/Fax

Practice location:
  • Phone: 843-332-5193
  • Fax: 843-332-7519
Mailing address:
  • Phone: 843-332-5193
  • Fax: 843-332-7519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number3848
License Number StateSC

VIII. Authorized Official

Name: MR. PAUL MICHAEL RAST
Title or Position: SEC-TRES
Credential: P. D. FASCP
Phone: 843-332-5193