Healthcare Provider Details

I. General information

NPI: 1386994549
Provider Name (Legal Business Name): DEBORAH CAUSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N MAIN ST
FOUNTAIN INN SC
29644-1907
US

IV. Provider business mailing address

203 NORTH MAIN STREET
FOUNTAIN INN SC
29644
US

V. Phone/Fax

Practice location:
  • Phone: 864-862-4414
  • Fax: 864-862-0592
Mailing address:
  • Phone: 864-862-4414
  • Fax: 864-862-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9440
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: