Provider Demographics
NPI:1760809057
Name:GANDY, CHARLES KELLY (PHARMD,)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KELLY
Last Name:GANDY
Suffix:
Gender:M
Credentials:PHARMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4216
Mailing Address - Country:US
Mailing Address - Phone:843-332-6581
Mailing Address - Fax:843-332-7783
Practice Address - Street 1:134 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4216
Practice Address - Country:US
Practice Address - Phone:843-332-6581
Practice Address - Fax:843-332-7783
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist