Provider Demographics
NPI:1871775841
Name:MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC
Entity type:Organization
Organization Name:MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OUTPATIENT PHARMACY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:NICOLE CROWE
Authorized Official - Last Name:BARNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:843-777-2166
Mailing Address - Street 1:501 E CHEVES ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506
Mailing Address - Country:US
Mailing Address - Phone:843-777-2166
Mailing Address - Fax:843-777-2950
Practice Address - Street 1:501 E CHEVES ST STE D
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506
Practice Address - Country:US
Practice Address - Phone:843-777-2166
Practice Address - Fax:843-777-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
SC62733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2089894OtherPK