Provider Demographics
NPI:1427789437
Name:MCALISTER, JUSTIN KEVIN (PHD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:KEVIN
Last Name:MCALISTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 EARL ST
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-2832
Mailing Address - Country:US
Mailing Address - Phone:864-340-3485
Mailing Address - Fax:864-697-6233
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JOANNA
Practice Address - State:SC
Practice Address - Zip Code:29351-1030
Practice Address - Country:US
Practice Address - Phone:864-697-6580
Practice Address - Fax:864-697-6233
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist