Healthcare Provider Details

I. General information

NPI: 1265816292
Provider Name (Legal Business Name): LAUREN ELIZABETH FACCHINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN ELIZABETH ALTMEYER

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N MAIN ST
WOODRUFF SC
29388-1845
US

IV. Provider business mailing address

121 N MAIN ST
WOODRUFF SC
29388-1845
US

V. Phone/Fax

Practice location:
  • Phone: 864-476-5902
  • Fax:
Mailing address:
  • Phone: 864-476-5902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449725
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27483
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: