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General NPI Number Information
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NPI Number | 1508348913
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Entity Type | Individual
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Provider Name | ANNAHITA MOT
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Gender | Female
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 618 FAIRVIEW RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-6707
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Country | US
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Telephone | 864-962-1839
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Fax |
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Provider Business Mailing Address
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Address Line | 3340 SHIPLEY ST APT 5416
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City | LADSON
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State | SC
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Zip | 29456-4185
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Country | US
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Telephone |
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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 | 37336
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License Number State | SC
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