Healthcare Provider Details

I. General information

NPI: 1891830642
Provider Name (Legal Business Name): CHERYL YONCE HARTVIGSEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8810 FARROW RD
COLUMBIA SC
29203-9727
US

IV. Provider business mailing address

8810 FARROW RD
COLUMBIA SC
29203-9727
US

V. Phone/Fax

Practice location:
  • Phone: 803-736-5915
  • Fax: 803-413-7333
Mailing address:
  • Phone: 803-736-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number6206
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: