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General NPI Number Information
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NPI Number | 1063787547
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Entity Type | Individual
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Provider Name | AVERITTE BURNEY PACE JR. PHARMACY BS
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Gender | Male
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Dates
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Enumeration Date | 03/15/2012
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 116 S MAIN ST
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City | NICHOLS
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State | SC
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Zip | 29581-0207
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Country | US
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Telephone | 843-526-2171
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Fax | 843-526-1705
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Provider Business Mailing Address
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Address Line | PO BOX 207 401 SOUTH NICHOLS STREET
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City | NICHOLS
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State | SC
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Zip | 29581-0207
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Country | US
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Telephone | 843-526-2257
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Fax | 843-526-1705
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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 | 3526
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License Number State | SC
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