Healthcare Provider Details

I. General information

NPI: 1437803590
Provider Name (Legal Business Name): MICHAEL ANTHONY MEZZADRI PHARM D, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 ASHLEY PHOSPHATE RD
NORTH CHARLESTON SC
29418-2823
US

IV. Provider business mailing address

222 WATER LOTUS DR
CHARLESTON SC
29414-8205
US

V. Phone/Fax

Practice location:
  • Phone: 843-767-4500
  • Fax:
Mailing address:
  • Phone: 508-922-4672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43329
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: