Provider Demographics
NPI:1497443758
Name:MCMICHAEL, BLAIR (PHARMD)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:MCMICHAEL
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 1:6233 SATCHEL FORD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-1513
Mailing Address - Country:US
Mailing Address - Phone:478-290-6601
Mailing Address - Fax:
Practice Address - Street 1:4840 FOREST DR STE 10
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-4810
Practice Address - Country:US
Practice Address - Phone:803-790-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist