Provider Demographics
NPI:1114347002
Name:DENNIS, DUANE CLIFTON
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:CLIFTON
Last Name:DENNIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 WHISKEY RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7956
Mailing Address - Country:US
Mailing Address - Phone:803-648-7766
Mailing Address - Fax:803-648-9121
Practice Address - Street 1:2035 WHISKEY RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7956
Practice Address - Country:US
Practice Address - Phone:803-648-7766
Practice Address - Fax:803-648-9121
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist