Provider Demographics
NPI:1376968867
Name:CAROLINA PODIATRIC MEDICAL ASSOCIATES, PA COMPOUND PHARMACY
Entity Type:Organization
Organization Name:CAROLINA PODIATRIC MEDICAL ASSOCIATES, PA COMPOUND PHARMACY
Other - Org Name:CPMA COMPOUND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MACKIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:803-292-1452
Mailing Address - Street 1:721 RICHLAND AVE W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-2438
Mailing Address - Country:US
Mailing Address - Phone:803-329-2145
Mailing Address - Fax:803-649-3848
Practice Address - Street 1:721 RICHLAND AVE W
Practice Address - Street 2:SUITE 100
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2438
Practice Address - Country:US
Practice Address - Phone:803-329-2145
Practice Address - Fax:803-649-3848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA PODIATRIC MEDICAL ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-20
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC59213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty