Healthcare Provider Details

I. General information

NPI: 1871362301
Provider Name (Legal Business Name): MRS. VIRGINIA S HARLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 SAVANNAH HWY
NORTH SC
29112-8180
US

IV. Provider business mailing address

PO BOX 85744
LEXINGTON SC
29073-0034
US

V. Phone/Fax

Practice location:
  • Phone: 803-247-2133
  • Fax:
Mailing address:
  • Phone: 803-518-2096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8139
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: