Healthcare Provider Details

I. General information

NPI: 1366411134
Provider Name (Legal Business Name): SERENA HAMMOND WESTMORELAND CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15891 WELLS HWY
SENECA SC
29678-1078
US

IV. Provider business mailing address

14052 S RADIO STATION RD
SENECA SC
29678-1013
US

V. Phone/Fax

Practice location:
  • Phone: 864-888-0405
  • Fax: 864-888-0019
Mailing address:
  • Phone: 864-882-9362
  • Fax: 864-888-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number22195
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: