Provider Demographics
NPI:1083942452
Name:REWERS, PAMELA S
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:S
Last Name:REWERS
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 1:3911 CAPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3411
Mailing Address - Country:US
Mailing Address - Phone:919-872-5233
Mailing Address - Fax:919-872-5281
Practice Address - Street 1:3911 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3411
Practice Address - Country:US
Practice Address - Phone:919-872-5233
Practice Address - Fax:919-872-5281
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18639183500000X
MP0053183500000X
IN26017688A183500000X
FLPS28945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC361924025OtherTAX ID