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General NPI Number Information
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NPI Number | 1013284744
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Entity Type | Individual
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Provider Name | PETER SHULL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 111 EDGEWOOD SQ
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-2824
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Country | US
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Telephone | 803-279-1190
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Fax |
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Provider Business Mailing Address
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Address Line | 622 LAKE FOREST RD
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City | COLUMBIA
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State | SC
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Zip | 29209-2578
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Country | US
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Telephone | 706-294-3231
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13485
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License Number State | SC
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