Healthcare Provider Details

I. General information

NPI: 1265891535
Provider Name (Legal Business Name): MARIO ALEJANDRO MACHADO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E BLACKSTOCK RD
SPARTANBURG SC
29301-3741
US

IV. Provider business mailing address

2600 SILVER THREAD LN APT 201
DUNCAN SC
29334-8556
US

V. Phone/Fax

Practice location:
  • Phone: 864-574-6288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number36131
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: