Individual
KAYCEE TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
480 NELSON BLVD, KINGSTREE, SC 29556-4025
(843) 354-3373
Mailing address
480 NELSON BLVD, KINGSTREE, SC 29556-4025
(843) 354-3373
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10340
SC
Other
Enumeration date
02/24/2011
Last updated
09/12/2012
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