=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285866236
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY ELLIOTT EDWARDS PHARM. D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2009
-----------------------------------------------------
Last Update Date | 08/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2209 W DEKALB ST
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29020-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-425-9527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 SOFT STONE DR
-----------------------------------------------------
City | BLYTHEWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29016-8180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-754-9878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 9808
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------