Provider Demographics
NPI:1174809024
Name:RHODES, DEREK BRADLEY (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:BRADLEY
Last Name:RHODES
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TAYLOR AT MARION STREET DEPT OF PHARMACY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29220-0001
Mailing Address - Country:US
Mailing Address - Phone:803-434-1314
Mailing Address - Fax:
Practice Address - Street 1:TAYLOR AT MARION ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29220-6863
Practice Address - Country:US
Practice Address - Phone:803-434-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20633183500000X
SC13373183500000X
PARP445807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist