Provider Demographics
NPI:1164906756
Name:CHANDLER, TYNESHA
Entity Type:Individual
Prefix:
First Name:TYNESHA
Middle Name:
Last Name:CHANDLER
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 1:109 CANE BREAK LN
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-4010
Mailing Address - Country:US
Mailing Address - Phone:843-377-6365
Mailing Address - Fax:
Practice Address - Street 1:2000 SAM RITTENBERG BLVD STE 134
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4629
Practice Address - Country:US
Practice Address - Phone:843-818-4683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist