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General NPI Number Information
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NPI Number | 1790078582
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Entity Type | Organization
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Legal Business Name | ADVANTAGE VETERANS SERVICES OF
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 2461 SIDNEYS RD
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City | WALTERBORO
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State | SC
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Zip | 29488-6783
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Country | US
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Telephone | 843-538-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5285
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City | ANDERSON
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State | SC
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Zip | 29623-5285
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Country | US
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Telephone | 864-224-3898
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Fax | 864-224-3609
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Authorized Official
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Title or Position | VICE PRESIDENT - OPERATIONS
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Name | HEYWARD HILLIARD
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Credential |
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Telephone | 864-224-3898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 9034
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License Number State | SC
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