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General NPI Number Information
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NPI Number | 1942899570
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Entity Type | Individual
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Provider Name | AMY STANSELL TATE RPH
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Gender | Female
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Dates
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Enumeration Date | 01/18/2021
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Last Update Date | 11/21/2021
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Provider Practice Location Address
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Address Line | 101 FOUNDERS BAY RD
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City | MURRELLS INLET
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State | SC
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Zip | 29576-8089
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Country | US
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Telephone | 843-651-8863
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Fax |
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Provider Business Mailing Address
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Address Line | 208 GRAY MANS LOOP
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City | PAWLEYS ISLAND
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State | SC
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Zip | 29585-6635
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Country | US
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Telephone | 865-591-5198
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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 | 12293
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 42921
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License Number State | SC
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