Healthcare Provider Details

I. General information

NPI: 1760776561
Provider Name (Legal Business Name): VANESSA KLIGMAN PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 MEADOWLARK ST
SHAW A F B SC
29152-5019
US

IV. Provider business mailing address

1343 SUNNYSIDE DR
COLUMBIA SC
29204-3322
US

V. Phone/Fax

Practice location:
  • Phone: 803-895-6464
  • Fax:
Mailing address:
  • Phone: 803-528-4286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12677
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: