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General NPI Number Information
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NPI Number | 1578053971
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Entity Type | Individual
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Provider Name | KATIE FOX
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Gender | Female
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 1600 10TH AVE
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City | CONWAY
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State | SC
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Zip | 29526-4112
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Country | US
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Telephone | 843-248-5015
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Fax |
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Provider Business Mailing Address
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Address Line | 150 SHERWOOD DR
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City | CONWAY
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State | SC
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Zip | 29526-3165
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Country | US
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Telephone | 843-602-5283
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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 | 13767
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License Number State | SC
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