Provider Demographics
NPI:1154722643
Name:PACK, MICHAEL BRETT (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRETT
Last Name:PACK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 WAVERLY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6875
Mailing Address - Country:US
Mailing Address - Phone:770-584-9702
Mailing Address - Fax:
Practice Address - Street 1:102 EXPRESS LN
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-5659
Practice Address - Country:US
Practice Address - Phone:843-393-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist