Provider Demographics
NPI:1417041617
Name:ARCHAMBAULT, MARY LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LEE
Last Name:ARCHAMBAULT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 CORNERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-9003
Mailing Address - Country:US
Mailing Address - Phone:843-762-3074
Mailing Address - Fax:
Practice Address - Street 1:109 BEE ST
Practice Address - Street 2:RALPH H. JOHNSON VAMC
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5703
Practice Address - Country:US
Practice Address - Phone:843-789-7674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC79401835P1200X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty