Healthcare Provider Details

I. General information

NPI: 1578620084
Provider Name (Legal Business Name): MCCLELLANVILLE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10035 HIGHWAY 17 NORTH
MCCLELLANVILLE SC
29458
US

IV. Provider business mailing address

P.O. BOX 548
MCCLELLANVILLE SC
29458
US

V. Phone/Fax

Practice location:
  • Phone: 843-887-3990
  • Fax: 843-887-3501
Mailing address:
  • Phone: 843-887-3990
  • Fax: 843-887-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateSC

VIII. Authorized Official

Name: MR. JONATHAN DAVID WELLS
Title or Position: PHARMACIST
Credential: RPH
Phone: 843-887-3990