Healthcare Provider Details

I. General information

NPI: 1366788465
Provider Name (Legal Business Name): ANNE MAIGUE SAN BUENAVENTURA PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2153 E MAIN ST
DUNCAN SC
29334-8724
US

IV. Provider business mailing address

2153 E MAIN ST
DUNCAN SC
29334-8724
US

V. Phone/Fax

Practice location:
  • Phone: 864-486-4706
  • Fax: 864-486-4713
Mailing address:
  • Phone: 864-486-4706
  • Fax: 864-486-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberSC16511
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: