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General NPI Number Information
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NPI Number | 1104141605
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HEALTH CONSULTANTS
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 401 6TH AVE S
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-3305
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Country | US
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Telephone | 843-267-9583
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Fax |
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Provider Business Mailing Address
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Address Line | 401 6TH AVE S
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-3305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | WANDA BLANTON NORRIS
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Credential |
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Telephone | 843-267-9583
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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 | 8963
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License Number State | SC
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