MEDICARE: CHRISTY CARTER GROVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11689	SC
2	183500000X	Pharmacist	20681	TN

General Provider Information

NPI Number	:	1063798072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY CARTER GROVER

Provider Business Mailing Address
First Line	:	1284 KNOX AVE
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-4055
Country	:	US
Telephone Number	:	803-442-4510
Fax Number	:	803-442-4515

Provider Business Practice Location Address
First Line	:	1284 KNOX AVE
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-4055
Country	:	US
Telephone Number	:	803-442-4510
Fax Number	:	803-442-4515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2011
Last Update Date	:	10/24/2011

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