Healthcare Provider Details

I. General information

NPI: 1982098786
Provider Name (Legal Business Name): CAROLYN KLINEFELTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 PADDOCK CLUB LN UNIT 108
FORT MILL SC
29715-5553
US

IV. Provider business mailing address

1631 PADDOCK CLUB LN UNIT 108
FORT MILL SC
29715-5553
US

V. Phone/Fax

Practice location:
  • Phone: 704-544-2092
  • Fax: 704-544-8251
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24767
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35902
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: