Provider Demographics
NPI:1043544877
Name:BULLINGTON, DEWEY RUSSELL JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:DEWEY
Middle Name:RUSSELL
Last Name:BULLINGTON
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2666 MAGNOLIA PLACE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7913
Mailing Address - Country:US
Mailing Address - Phone:864-934-1974
Mailing Address - Fax:
Practice Address - Street 1:395 N HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3919
Practice Address - Country:US
Practice Address - Phone:843-899-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-26
Last Update Date:2009-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist