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General NPI Number Information
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NPI Number | 1679870760
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Entity Type | Individual
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Provider Name | ART BASIL KALTSOUNIS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 300 S KINGS HIGHHWAY
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City | MYRTLE BEACH
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State | SC
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Zip | 29577
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Country | US
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Telephone | 843-324-3030
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 267
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City | MT PLEASANT
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State | SC
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Zip | 29465-0267
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Country | US
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Telephone | 843-324-3030
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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 | 9878
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License Number State | SC
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