Provider Demographics
NPI:1558483438
Name:FLEMING, CASSANDRA TISDALE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:TISDALE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W E JEFFCOAT RD
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-9162
Mailing Address - Country:US
Mailing Address - Phone:803-568-2523
Mailing Address - Fax:803-568-4407
Practice Address - Street 1:1180 FIVE CHOP RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-7049
Practice Address - Country:US
Practice Address - Phone:803-539-0542
Practice Address - Fax:803-536-6698
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC005658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist