Healthcare Provider Details

I. General information

NPI: 1053738864
Provider Name (Legal Business Name): AMY ROYAL PA-C, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BILL FRIES DR BUILDING F
HILTON HEAD ISLAND SC
29926-2730
US

IV. Provider business mailing address

35 BILL FRIES DR BUILDING F
HILTON HEAD ISLAND SC
29926-2730
US

V. Phone/Fax

Practice location:
  • Phone: 843-681-6668
  • Fax:
Mailing address:
  • Phone: 843-681-6668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2090
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12363
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: