MEDICARE: AMY E ZORN 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	3336C0003X	Community/Retail Pharmacy	16197	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9165	OTHER	SC	SCBOP

General Provider Information

NPI Number	:	1861901886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY E ZORN RPH

Provider Business Mailing Address
First Line	:	12935 MAIN ST
Second Line	:
City	:	WILLISTON
State	:	SC
Zip	:	29853-2321
Country	:	US
Telephone Number	:	803-266-3356
Fax Number	:	803-266-3358

Provider Business Practice Location Address
First Line	:	12935 MAIN ST
Second Line	:
City	:	WILLISTON
State	:	SC
Zip	:	29853-2321
Country	:	US
Telephone Number	:	803-266-3356
Fax Number	:	803-266-3358

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

Provider Enumeration Date	:	09/21/2017
Last Update Date	:	06/16/2018

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Directions to “ AMY E ZORN RPH” Practice Location

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