Provider Demographics
NPI:1932654506
Name:MILEJCZAK, AMELIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:MILEJCZAK
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 1:40 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-9406
Mailing Address - Country:US
Mailing Address - Phone:803-438-5537
Mailing Address - Fax:
Practice Address - Street 1:40 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-9406
Practice Address - Country:US
Practice Address - Phone:803-438-5537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC368191835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC36819OtherSOUTH CAROLINA BOARD OF PHARMACY