MEDICARE: ANNA MARIE MCCLINTOCK 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	36732	SC

General Provider Information

NPI Number	:	1871048348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA MARIE MCCLINTOCK PHARMD

Provider Business Mailing Address
First Line	:	14 DENDON CT
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29680-7073
Country	:	US
Telephone Number	:	803-586-1535
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 FAIRVIEW RD STE C
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29680-6777
Country	:	US
Telephone Number	:	864-962-0251
Fax Number	:

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

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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