MEDICARE: DAVID OUELLET

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	35583	SC

General Provider Information

NPI Number	:	1306242664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID OUELLET

Provider Business Mailing Address
First Line	:	4001 CORONADO DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-5409
Country	:	US
Telephone Number	:	803-479-8419
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 SAMS CROSSING RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-9591
Country	:	US
Telephone Number	:	803-788-0535
Fax Number	:	803-788-8750

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

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	11/14/2014

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Directions to “ DAVID OUELLET ” Practice Location

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