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General NPI Number Information
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NPI Number | 1376829374
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Entity Type | Individual
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Provider Name | DENISE G. DERRICK
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Gender | Female
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 05/15/2020
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Provider Practice Location Address
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Address Line | 4079 AUGUSTA HIGHWAY SUITE A
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City | GILBERT
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State | SC
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Zip | 29054
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Country | US
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Telephone | 803-892-6789
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Fax |
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Provider Business Mailing Address
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Address Line | 2320 RIDGE RD
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City | LEESVILLE
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State | SC
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Zip | 29070-8013
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Country | US
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Telephone | 803-604-9115
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 9699
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License Number State | SC
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