MEDICARE: MS. PAMELA JEAN DECHELLIS R.PH

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	23241	MA
2	183500000X	Pharmacist	36434	SC

General Provider Information

NPI Number	:	1366763419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA JEAN DECHELLIS R.PH

Provider Business Mailing Address
First Line	:	1310 N FRASER ST
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29440-2800
Country	:	US
Telephone Number	:	843-527-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 N FRASER ST
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29440-2800
Country	:	US
Telephone Number	:	843-527-2223
Fax Number	:

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

Provider Enumeration Date	:	06/11/2010
Last Update Date	:	01/25/2017

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