=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700428521
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARAYA RAMDHANI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2019
-----------------------------------------------------
Last Update Date | 10/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 KNOX ABBOTT DR
-----------------------------------------------------
City | CAYCE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29033-4395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-926-0312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1508 GUNTER DR
-----------------------------------------------------
City | WEST COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-466-3128
-----------------------------------------------------
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 | 42224
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------