Provider Demographics
NPI:1669286340
Name:DEAN, MADELINE PHAE (PHARMD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:PHAE
Last Name:DEAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BLUE FESCUE WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-5148
Mailing Address - Country:US
Mailing Address - Phone:843-822-7293
Mailing Address - Fax:
Practice Address - Street 1:1025 W DEKALB ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4162
Practice Address - Country:US
Practice Address - Phone:888-400-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist