Healthcare Provider Details

I. General information

NPI: 1962491332
Provider Name (Legal Business Name): BETTIE BERNARD STOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 W LIBERTY ST
SUMTER SC
29150-5240
US

IV. Provider business mailing address

35 W LIBERTY ST
SUMTER SC
29150-5240
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-7283
  • Fax: 803-775-7908
Mailing address:
  • Phone: 803-773-7283
  • Fax: 803-775-7908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6112
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2451
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: