Provider Demographics
NPI:1013567767
Name:WEBB, AMANDA LAUREN
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LAUREN
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-2626
Mailing Address - Country:US
Mailing Address - Phone:864-923-1267
Mailing Address - Fax:
Practice Address - Street 1:180 SCENIC PLAZA DR
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:SC
Practice Address - Zip Code:29696-2536
Practice Address - Country:US
Practice Address - Phone:864-638-7217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-15
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist