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General NPI Number Information
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NPI Number | 1225100159
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Entity Type | Individual
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Provider Name | MS. KIM RUSH
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 715 H.C. RAYSOR DR.
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City | ST. MATTHEWS
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State | SC
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Zip | 29135
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Country | US
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Telephone | 803-655-7753
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 492
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City | NORWAY
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State | SC
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Zip | 29113-0492
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Country | US
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Telephone | 803-263-4875
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 12732
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License Number State | SC
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