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General NPI Number Information
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NPI Number | 1205823309
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Entity Type | Organization
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Legal Business Name | MCLEOD PHARMACY INC
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 127 N MAIN ST
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City | BISHOPVILLE
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State | SC
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Zip | 29010-1413
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Country | US
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Telephone | 803-484-6115
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Fax | 803-484-4128
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Provider Business Mailing Address
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Address Line | 127 N MAIN ST
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City | BISHOPVILLE
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State | SC
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Zip | 29010-1413
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Country | US
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Telephone | 803-484-6115
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Fax | 803-484-4128
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Authorized Official
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Title or Position | RPH
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Name | DAVID ROBERSON
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Credential | RPH
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Telephone | 803-484-6115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 8364
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 20160142
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 8364
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License Number State | SC
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