Healthcare Provider Details

I. General information

NPI: 1386938140
Provider Name (Legal Business Name): JEANIE KALDEN PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 SCENIC PLAZA DR
WEST UNION SC
29696-2536
US

IV. Provider business mailing address

3519 CLEMSON BOULEVARD T-1198
CLEMSON SC
29621
US

V. Phone/Fax

Practice location:
  • Phone: 864-638-3976
  • Fax:
Mailing address:
  • Phone: 864-224-3972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051038130
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11722
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: