Healthcare Provider Details

I. General information

NPI: 1528051497
Provider Name (Legal Business Name): MRS. ELLEN B. OWANS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S MAIN ST
SUMMERVILLE SC
29483-6008
US

IV. Provider business mailing address

114 FIVE IRON CIR
SUMMERVILLE SC
29483-3151
US

V. Phone/Fax

Practice location:
  • Phone: 843-873-2531
  • Fax: 843-873-4572
Mailing address:
  • Phone: 843-875-0827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number13179
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: