MEDICARE: LISA ALMOND THORNDYKE BS PHARM 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	183500000X	Pharmacist	9203	NC
2	183500000X	Pharmacist	006654	SC

General Provider Information

NPI Number	:	1962018994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ALMOND THORNDYKE BS PHARM RPH

Provider Business Mailing Address
First Line	:	650 ELLIS OAK DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3089
Country	:	US
Telephone Number	:	843-876-7043
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 ELLIS OAK DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3089
Country	:	US
Telephone Number	:	843-876-7043
Fax Number	:

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

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	09/16/2020

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