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General NPI Number Information
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NPI Number | 1942559240
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Entity Type | Individual
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Provider Name | DR. ADAM WADE CHITTAM
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Gender | Male
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 120 W COLUMBIA AVE
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City | BATESBURG
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State | SC
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Zip | 29006-2100
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Country | US
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Telephone | 803-532-5564
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Fax | 803-532-8196
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Provider Business Mailing Address
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Address Line | 252 WINTERBERRY LOOP
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City | LEXINGTON
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State | SC
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Zip | 29072-8153
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Country | US
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Telephone | 803-520-7948
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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 | 12720
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License Number State | SC
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