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General NPI Number Information
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NPI Number | 1740848787
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Entity Type | Individual
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Provider Name | JUSTIN MICHAEL OVERSTREET PHARM D.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 1020 ORANGE GROVE RD
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City | CHARLESTON
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State | SC
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Zip | 29407-3756
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Country | US
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Telephone | 843-556-4064
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Fax |
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Provider Business Mailing Address
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Address Line | 1899 BERMUDA STONE RD
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City | CHARLESTON
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State | SC
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Zip | 29414-8150
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Country | US
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Telephone | 540-816-0330
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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 | 41955
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License Number State | SC
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