Provider Demographics
NPI:1275524399
Name:VANDENBERG, AMY M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:VANDENBERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HARRODS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4355
Mailing Address - Country:US
Mailing Address - Phone:843-792-0179
Mailing Address - Fax:
Practice Address - Street 1:67 PRESIDENT ST
Practice Address - Street 2:IOP 3 NORTH ROOM 339
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5712
Practice Address - Country:US
Practice Address - Phone:843-792-0179
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC99581835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric