Healthcare Provider Details

I. General information

NPI: 1114072576
Provider Name (Legal Business Name): MS. KELLY SUSAN LARKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N MAIN ST
GREER SC
29650-1921
US

IV. Provider business mailing address

6 ROLLINGREEN RD
GREER SC
29651-5975
US

V. Phone/Fax

Practice location:
  • Phone: 864-877-0753
  • Fax: 864-877-5171
Mailing address:
  • Phone: 864-320-1264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number23882
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: