Provider Demographics
NPI:1700136074
Name:MACKO, CHARLES (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:MACKO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HOLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7170
Mailing Address - Country:US
Mailing Address - Phone:843-824-9374
Mailing Address - Fax:
Practice Address - Street 1:5215 ASHLEY PHOSPHATE RD
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-2823
Practice Address - Country:US
Practice Address - Phone:843-767-4500
Practice Address - Fax:843-767-3175
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist