MEDICARE: PAMEA JACINDA MAZYCK PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	009957	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	183500000X-PHARMACIS	OTHER	SC	18- PHARMACY SERVICE PROVIDER

General Provider Information

NPI Number	:	1043501521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMEA JACINDA MAZYCK PHARMD

Provider Business Mailing Address
First Line	:	8395 DORCHESTER RD
Second Line	:	STORE 6076
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-2916
Country	:	US
Telephone Number	:	843-207-1578
Fax Number	:

Provider Business Practice Location Address
First Line	:	8395 DORCHESTER RD
Second Line	:	STORE 6076
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-2916
Country	:	US
Telephone Number	:	843-207-1578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	05/02/2011

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