Provider Demographics
NPI:1912423153
Name:DAIL, MARY VIVAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:VIVAS
Last Name:DAIL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:DAIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:200 N BELTLINE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-7403
Mailing Address - Country:US
Mailing Address - Phone:843-758-6087
Mailing Address - Fax:843-758-6088
Practice Address - Street 1:200 N BELTLINE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-7403
Practice Address - Country:US
Practice Address - Phone:843-758-6087
Practice Address - Fax:843-758-6088
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91811835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty