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General NPI Number Information
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NPI Number | 1225373574
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Entity Type | Individual
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Provider Name | TAVIA S. FOGLE RPH
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Gender | Female
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 4633 SAVANNAH HWY
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City | NORTH
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State | SC
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Zip | 29112-8180
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Country | US
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Telephone | 803-247-2133
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Fax | 803-247-3081
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Provider Business Mailing Address
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Address Line | 4633 SAVANNAH HWY
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City | NORTH
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State | SC
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Zip | 29112-8180
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Country | US
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Telephone | 803-247-2133
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Fax | 803-247-3081
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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 | 8772
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License Number State | SC
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