Provider Demographics
NPI:1649691643
Name:PEAGLER, MELANIE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:PEAGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 BUSH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-6804
Mailing Address - Country:US
Mailing Address - Phone:803-750-3284
Mailing Address - Fax:
Practice Address - Street 1:1180 DUTCH FORK RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8874
Practice Address - Country:US
Practice Address - Phone:803-781-7877
Practice Address - Fax:803-781-7810
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist