Provider Demographics
NPI:1871012005
Name:MAXWELL, DEMARGAS SHAUN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEMARGAS
Middle Name:SHAUN
Last Name:MAXWELL
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 1:2515 FLEMING DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-6759
Mailing Address - Country:US
Mailing Address - Phone:864-934-6522
Mailing Address - Fax:
Practice Address - Street 1:4405 HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29626-5216
Practice Address - Country:US
Practice Address - Phone:864-226-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist