Healthcare Provider Details

I. General information

NPI: 1497278345
Provider Name (Legal Business Name): BRYCE ALAN STAFFORD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 ELM STREET WEST
HAMPTON SC
29924
US

IV. Provider business mailing address

103 REMINGTON PL
GOOSE CREEK SC
29445-5406
US

V. Phone/Fax

Practice location:
  • Phone: 803-943-0683
  • Fax: 803-943-0783
Mailing address:
  • Phone: 843-323-0199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37239
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: