Healthcare Provider Details

I. General information

NPI: 1104961077
Provider Name (Legal Business Name): MRS. LINDA NANCE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 MCCLURE CT
FLORENCE SC
29505
US

IV. Provider business mailing address

PO BOX 3206
FLORENCE SC
29502-3206
US

V. Phone/Fax

Practice location:
  • Phone: 843-679-1881
  • Fax: 843-679-1887
Mailing address:
  • Phone: 843-393-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number19179
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: