Provider Demographics
NPI:1174804884
Name:BAUCOM, DARIN (RPH)
Entity type:Individual
Prefix:
First Name:DARIN
Middle Name:
Last Name:BAUCOM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1313
Mailing Address - Country:US
Mailing Address - Phone:843-626-7400
Mailing Address - Fax:843-445-6483
Practice Address - Street 1:1241 38TH AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1313
Practice Address - Country:US
Practice Address - Phone:843-626-7400
Practice Address - Fax:843-445-6483
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10009183500000X
NC11297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist