Provider Demographics
NPI:1063127991
Name:BOUCHARD, MEGAN (PHARMD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BOUCHARD
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 1:630 JAMESON DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-9797
Mailing Address - Country:US
Mailing Address - Phone:207-551-6175
Mailing Address - Fax:
Practice Address - Street 1:115 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-6051
Practice Address - Country:US
Practice Address - Phone:864-757-7087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5636183500000X
SC38080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist