Healthcare Provider Details

I. General information

NPI: 1497396014
Provider Name (Legal Business Name): NICOLE BUZZARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

119 LAYTON WAY
GEORGETOWN TX
78633-1853
US

V. Phone/Fax

Practice location:
  • Phone: 806-776-4000
  • Fax:
Mailing address:
  • Phone: 512-633-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29198
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: