Provider Demographics
NPI:1518022789
Name:MEDICAL ARTS PHARMACY
Entity Type:Organization
Organization Name:MEDICAL ARTS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC-TRES
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RAST
Authorized Official - Suffix:
Authorized Official - Credentials:P D FASCP
Authorized Official - Phone:843-332-5193
Mailing Address - Street 1:206 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4304
Mailing Address - Country:US
Mailing Address - Phone:843-332-5193
Mailing Address - Fax:843-332-7519
Practice Address - Street 1:206 S 2ND ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4304
Practice Address - Country:US
Practice Address - Phone:843-332-5193
Practice Address - Fax:843-332-7519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38481835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC702116Medicaid