MEDICARE: LANCE CURRY MCRAE

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	012206	SC

General Provider Information

NPI Number	:	1851548796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE CURRY MCRAE

Provider Business Mailing Address
First Line	:	741 WOODRUFF RD APT 2233
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-6809
Country	:	US
Telephone Number	:	843-862-6560
Fax Number	:

Provider Business Practice Location Address
First Line	:	1292 S PLEASANTBURG DR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-1329
Country	:	US
Telephone Number	:	864-299-3141
Fax Number	:

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

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	08/22/2008

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