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General NPI Number Information
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NPI Number | 1952896300
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Entity Type | Individual
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Provider Name | HLEB FEDAROVICH
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Gender | Male
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 104 W BUTLER RD
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City | MAULDIN
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State | SC
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Zip | 29662-2535
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Country | US
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Telephone | 864-297-0739
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Fax |
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Provider Business Mailing Address
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Address Line | 437 PLANTERS TRACE DR
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City | CHARLESTON
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State | SC
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Zip | 29412-8306
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Country | US
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Telephone | 843-754-5148
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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 | 37654
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License Number State | SC
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