Healthcare Provider Details

I. General information

NPI: 1093191009
Provider Name (Legal Business Name): MARY MARGARET ZELLER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 09/29/2026
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 CHURCH ST
CONWAY SC
29526-4824
US

IV. Provider business mailing address

1041 BLUE STEM DR UNIT 37A
PAWLEYS ISLAND SC
29585-8224
US

V. Phone/Fax

Practice location:
  • Phone: 843-248-6302
  • Fax:
Mailing address:
  • Phone: 843-979-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0328437
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038437
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43791
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: