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General NPI Number Information
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NPI Number | 1063127991
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Entity Type | Individual
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Provider Name | MEGAN BOUCHARD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 115 HIGHWAY 14
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-6051
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Country | US
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Telephone | 864-757-7087
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Fax |
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Provider Business Mailing Address
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Address Line | 630 JAMESON DR
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City | PIEDMONT
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State | SC
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Zip | 29673-9797
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Country | US
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Telephone | 207-551-6175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PR5636
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 38080
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License Number State | SC
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