MEDICARE: CHRISTOPHER MICHAEL KOWALSKI

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	14432	SC

General Provider Information

NPI Number	:	1467882092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER MICHAEL KOWALSKI

Provider Business Mailing Address
First Line	:	1300 LONG GROVE DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-9462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 LONG GROVE DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-9462
Country	:	US
Telephone Number	:	843-399-1973
Fax Number	:

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

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	11/18/2013

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