=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356356752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA K SPRUILL PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 02/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2110 BELLS HWY
-----------------------------------------------------
City | WALTERBORO
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29488-6978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-539-1555
-----------------------------------------------------
Fax | 843-539-1558
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 GARDEN LILY LN
-----------------------------------------------------
City | SUMMERVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29485-9230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-709-3791
-----------------------------------------------------
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 | 12181
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------