Healthcare Provider Details

I. General information

NPI: 1013567767
Provider Name (Legal Business Name): AMANDA WEBB DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2019
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E MAIN ST
LAURENS SC
29360-3636
US

IV. Provider business mailing address

309 S WOODROW ST
CLINTON SC
29325-2557
US

V. Phone/Fax

Practice location:
  • Phone: 864-984-1492
  • Fax: 864-984-9463
Mailing address:
  • Phone: 864-923-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42237
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: