Provider Demographics
NPI:1114582038
Name:PATZ, NICOLE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:PATZ
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2788
Mailing Address - Country:US
Mailing Address - Phone:843-549-3214
Mailing Address - Fax:843-549-3216
Practice Address - Street 1:550 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2788
Practice Address - Country:US
Practice Address - Phone:843-549-3214
Practice Address - Fax:843-549-3216
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26690183700000X
540107010168805183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
5401-0701-0168-805OtherPHARMACY TECHNICIAN CERTIFICATION BOARD
SC26690OtherSOUTH CAROLINA LABOR, LICENSING AND REGULATION
SC330558OtherNABP