Individual
MINA GAID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1303 38TH AVENUE NORTH, MYRTLE BEACH, SC 29579
(843) 626-3951
Mailing address
605 WATERWAY VILLAGE- 31-H, MYRTLE BEACH, SC 29579
(843) 504-5677
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
35793
SC
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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