MEDICARE: BENJAMIN MCCANN 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	37234	SC

General Provider Information

NPI Number	:	1528581774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN MCCANN PHARMD

Provider Business Mailing Address
First Line	:	107 KNOX ABBOTT DR UNIT 1322
Second Line	:
City	:	CAYCE
State	:	SC
Zip	:	29033-4408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-3109
Country	:	US
Telephone Number	:	803-787-7362
Fax Number	:

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

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	07/19/2017

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