Healthcare Provider Details

I. General information

NPI: 1467882092
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL KOWALSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 LONG GROVE DR
MOUNT PLEASANT SC
29464-9462
US

IV. Provider business mailing address

1300 LONG GROVE DR
MOUNT PLEASANT SC
29464-9462
US

V. Phone/Fax

Practice location:
  • Phone: 843-399-1973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14432
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: