1578053971 NPI number — KATIE FOX

Table of content: KATIE FOX (NPI 1578053971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578053971 NPI number — KATIE FOX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOX
Provider First Name:
KATIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578053971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 SHERWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29526-3165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-602-5283
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 10TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29526-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-248-5015
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2018

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:  13767 , 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)

  • Identifier: 13767 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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