Healthcare Provider Details

I. General information

NPI: 1871643874
Provider Name (Legal Business Name): LOIS MCCRACKEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N WASHINGTON ST
SUMTER SC
29150-4949
US

IV. Provider business mailing address

PO BOX 1982
SUMTER SC
29151-1982
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-8874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number3967
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: