Individual
MICAELA ANNE CISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1180 DUTCH FORK RD, IRMO, SC 29063-8874
(803) 781-7877
Mailing address
1504 PIEDMONT PARK RD, TAYLORS, SC 29687-2047
(864) 498-3238
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
42672
SC
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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