Provider Demographics
NPI:1760549596
Name:OSEAN, MARY VEANNA (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:VEANNA
Last Name:OSEAN
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 1:503 THURGOOD MARSHALL HWY
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4107
Mailing Address - Country:US
Mailing Address - Phone:843-355-3136
Mailing Address - Fax:843-355-3137
Practice Address - Street 1:503 THURGOOD MARSHALL HWY
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4107
Practice Address - Country:US
Practice Address - Phone:843-355-3136
Practice Address - Fax:843-355-3137
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC725802Medicaid