Provider Demographics
NPI:1235487034
Name:WEEMS, SUSAN ELIZABETH CORLEY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELIZABETH CORLEY
Last Name:WEEMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:CORLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:616 PISTOIA LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-8418
Mailing Address - Country:US
Mailing Address - Phone:803-309-8190
Mailing Address - Fax:
Practice Address - Street 1:1150 SEABOARD ST
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-6517
Practice Address - Country:US
Practice Address - Phone:843-626-5034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9789OtherSTATE LICENSE NO.