Healthcare Provider Details

I. General information

NPI: 1336876010
Provider Name (Legal Business Name): AMARI DAVIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7412 BROAD RIVER RD
IRMO SC
29063-9662
US

IV. Provider business mailing address

126 HERITAGE VILLAGE LN
COLUMBIA SC
29212-3555
US

V. Phone/Fax

Practice location:
  • Phone: 803-749-3046
  • Fax:
Mailing address:
  • Phone: 803-394-7540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43597
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: