MEDICARE: ELLEN AUTEN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	SC11299	SC
2	183500000X	Pharmacist	11299	SC

General Provider Information

NPI Number	:	1437409125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN AUTEN RPH

Provider Business Mailing Address
First Line	:	3525 PARK AVENUE BLVD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-7242
Country	:	US
Telephone Number	:	843-375-7031
Fax Number	:	843-556-9720

Provider Business Practice Location Address
First Line	:	3525 PARK AVENUE BLVD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-7242
Country	:	US
Telephone Number	:	843-375-7031
Fax Number	:	843-375-7022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	07/11/2023

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