Healthcare Provider Details

I. General information

NPI: 1194370411
Provider Name (Legal Business Name): VIRGINIA ELLIS POWELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N BROOKS ST
MANNING SC
29102-3206
US

IV. Provider business mailing address

12 N BROOKS ST
MANNING SC
29102-3206
US

V. Phone/Fax

Practice location:
  • Phone: 803-435-2511
  • Fax: 803-435-4235
Mailing address:
  • Phone: 803-435-2511
  • Fax: 803-435-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42160
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: