Healthcare Provider Details

I. General information

NPI: 1710237268
Provider Name (Legal Business Name): ELIZABETH CAULDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 US HWY 321 BYPASS SOUTH
WINNSBORO SC
29180
US

IV. Provider business mailing address

27 US HWY 321 BYPASS SOUTH
WINNSBORO SC
29180
US

V. Phone/Fax

Practice location:
  • Phone: 803-635-3012
  • Fax: 803-635-7472
Mailing address:
  • Phone: 803-635-3012
  • Fax: 803-635-7472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5157
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: