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General NPI Number Information
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NPI Number | 1578620084
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Entity Type | Organization
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Legal Business Name | MCCLELLANVILLE PHARMACY INC.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10035 HIGHWAY 17 NORTH
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City | MCCLELLANVILLE
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State | SC
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Zip | 29458
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Country | US
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Telephone | 843-887-3990
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Fax | 843-887-3501
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Provider Business Mailing Address
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Address Line | P.O. BOX 548
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City | MCCLELLANVILLE
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State | SC
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Zip | 29458
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Country | US
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Telephone | 843-887-3990
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Fax | 843-887-3501
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. JONATHAN DAVID WELLS
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Credential | RPH
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Telephone | 843-887-3990
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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 |
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License Number State | SC
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