Provider Demographics
NPI:1619227014
Name:DUBOSE, HALLIE MCNAIR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HALLIE
Middle Name:MCNAIR
Last Name:DUBOSE
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 1:120 NORTH LONGSTREET ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556
Mailing Address - Country:US
Mailing Address - Phone:843-354-5565
Mailing Address - Fax:
Practice Address - Street 1:120 NORTH LONGSTREET ST
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556
Practice Address - Country:US
Practice Address - Phone:843-354-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist