Provider Demographics
NPI:1316244650
Name:MACK-GARVIN, KAMEAKA LATRICE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAMEAKA
Middle Name:LATRICE
Last Name:MACK-GARVIN
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 1:1326 N JEFFERIES BLVD
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2733
Mailing Address - Country:US
Mailing Address - Phone:843-549-6781
Mailing Address - Fax:843-549-9642
Practice Address - Street 1:1326 N JEFFERIES BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2733
Practice Address - Country:US
Practice Address - Phone:843-549-6781
Practice Address - Fax:843-549-9642
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist