Provider Demographics
NPI:1619397007
Name:MCCANTS, CHARLES R JR (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:MCCANTS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5556 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7989
Mailing Address - Country:US
Mailing Address - Phone:803-808-3747
Mailing Address - Fax:803-808-3746
Practice Address - Street 1:5556 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7989
Practice Address - Country:US
Practice Address - Phone:803-808-3747
Practice Address - Fax:803-808-3746
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist