MEDICARE: MRS. JANICE CARINO CHESTNUT 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	37920	SC

General Provider Information

NPI Number	:	1073098620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE CARINO CHESTNUT PHARMD

Provider Business Mailing Address
First Line	:	2820 BROOKS ST
Second Line	:
City	:	SULLIVANS ISLAND
State	:	SC
Zip	:	29482-9673
Country	:	US
Telephone Number	:	843-345-0906
Fax Number	:

Provider Business Practice Location Address
First Line	:	2195 TEA PLANTER LN
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-7804
Country	:	US
Telephone Number	:	843-881-2583
Fax Number	:

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

Provider Enumeration Date	:	09/29/2018
Last Update Date	:	09/29/2018

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