Provider Demographics
NPI:1598814683
Name:RAST, MIKE (PD FASCP)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:RAST
Suffix:
Gender:M
Credentials:PD FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:843-332-2589
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:843-332-2589
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38481835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric