MEDICARE: TORI C ANDERSON

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	183500000X	Pharmacist	12739	SC

General Provider Information

NPI Number	:	1548568504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TORI C ANDERSON

Provider Business Mailing Address
First Line	:	1584 CENTRAL AVE
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-5528
Country	:	US
Telephone Number	:	843-871-9289
Fax Number	:	843-871-2925

Provider Business Practice Location Address
First Line	:	1584 CENTRAL AVE
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-5528
Country	:	US
Telephone Number	:	843-871-9289
Fax Number	:	843-871-2925

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

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	03/01/2011

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Directions to “ TORI C ANDERSON ” Practice Location

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