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General NPI Number Information
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NPI Number | 1669286340
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Entity Type | Individual
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Provider Name | MADELINE PHAE DEAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1025 W DEKALB ST
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City | CAMDEN
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State | SC
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Zip | 29020-4162
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Country | US
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Telephone | 888-400-1293
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Fax |
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Provider Business Mailing Address
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Address Line | 27 BLUE FESCUE WAY
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City | COLUMBIA
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State | SC
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Zip | 29209-5148
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Country | US
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Telephone | 843-822-7293
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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 | 43618
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License Number State | SC
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