Healthcare Provider Details

I. General information

NPI: 1689964033
Provider Name (Legal Business Name): PEGGY DIMETRA HENKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PEGGY DIMETRA HENKEL RPH

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 S HIGHWAY 17
MURRELLS INLET SC
29576-7624
US

IV. Provider business mailing address

2939 S HIGHWAY 17
MURRELLS INLET SC
29576-7624
US

V. Phone/Fax

Practice location:
  • Phone: 843-235-7110
  • Fax: 843-235-7111
Mailing address:
  • Phone: 843-235-7110
  • Fax: 843-235-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number43519
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: