1750427985 NPI number — MRS. DEBRA SHOWALTER MUNDIE RPH

Table of content: MRS. DEBRA SHOWALTER MUNDIE RPH (NPI 1750427985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750427985 NPI number — MRS. DEBRA SHOWALTER MUNDIE RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNDIE
Provider First Name:
DEBRA
Provider Middle Name:
SHOWALTER
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:
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:
1750427985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2615 SARASOTA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29577-4740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-444-1080
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3381 PHILLIS BOULEVARD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF VETERANS AFFAIRS PRIMARY CARE CLINIC
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-477-0177
Provider Business Practice Location Address Fax Number:
843-232-2428
Provider Enumeration Date:
01/29/2007

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:  0202006407 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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