Healthcare Provider Details

I. General information

NPI: 1679174650
Provider Name (Legal Business Name): KRISTIN WELBORN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD
GREENVILLE SC
29605-4210
US

IV. Provider business mailing address

701 GROVE RD
GREENVILLE SC
29605-4210
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-5336
  • Fax: 864-455-1637
Mailing address:
  • Phone: 864-455-5336
  • Fax: 864-455-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number12682
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: