Healthcare Provider Details

I. General information

NPI: 1649189804
Provider Name (Legal Business Name): MARY HEAPHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3735 RENEE DR
MYRTLE BEACH SC
29579-4109
US

IV. Provider business mailing address

3735 RENEE DR
MYRTLE BEACH SC
29579-4109
US

V. Phone/Fax

Practice location:
  • Phone: 843-273-7102
  • Fax:
Mailing address:
  • Phone: 843-273-7102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number67808
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: