Provider Demographics
NPI:1922528561
Name:FACKLER, CALEB A (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:A
Last Name:FACKLER
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 CENTRE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-6927
Mailing Address - Country:US
Mailing Address - Phone:843-740-5484
Mailing Address - Fax:843-740-6766
Practice Address - Street 1:4920 CENTRE POINTE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6927
Practice Address - Country:US
Practice Address - Phone:843-740-5484
Practice Address - Fax:843-740-6766
Is Sole Proprietor?:No
Enumeration Date:2017-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC37128OtherSTATE LICENSE