1518399807 NPI number — MRS. THERESA GAYLE SAUNDERS RPH

Table of content: MRS. THERESA GAYLE SAUNDERS RPH (NPI 1518399807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518399807 NPI number — MRS. THERESA GAYLE SAUNDERS RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAUNDERS
Provider First Name:
THERESA
Provider Middle Name:
GAYLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEDGECOCK
Provider Other First Name:
THERESA
Provider Other Middle Name:
GAYLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518399807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 SAM RITTENBURG BLVD SUITE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29407-5006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-573-4776
Provider Business Mailing Address Fax Number:
843-852-0219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 SAM RITTENBURG BLVD SUITE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29407-5006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-573-4773
Provider Business Practice Location Address Fax Number:
843-852-0219
Provider Enumeration Date:
08/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  6581 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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