Provider Demographics
NPI:1114133220
Name:OUZTS, MICHAEL A (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:OUZTS
Suffix:
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 1:419 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-2918
Mailing Address - Country:US
Mailing Address - Phone:803-433-2212
Mailing Address - Fax:803-433-2656
Practice Address - Street 1:419 S MILL ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102
Practice Address - Country:US
Practice Address - Phone:803-433-2212
Practice Address - Fax:803-433-2656
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2017-03-15
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2017-03-15
Provider Licenses
StateLicense IDTaxonomies
SC6194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC732512Medicaid