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General NPI Number Information
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NPI Number | 1154722643
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Entity Type | Individual
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Provider Name | MICHAEL BRETT PACK PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 102 EXPRESS LN
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City | DARLINGTON
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State | SC
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Zip | 29532-5659
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Country | US
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Telephone | 843-393-6448
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Fax |
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Provider Business Mailing Address
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Address Line | 2152 WAVERLY WOODS DR
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City | FLORENCE
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State | SC
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Zip | 29505-6875
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Country | US
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Telephone | 770-584-9702
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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 | 35807
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License Number State | SC
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