Provider Demographics
NPI:1508287582
Name:PREWITT, KATHLEEN (RPH)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PREWITT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-8102
Mailing Address - Country:US
Mailing Address - Phone:803-957-1321
Mailing Address - Fax:803-957-1356
Practice Address - Street 1:1780 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-8102
Practice Address - Country:US
Practice Address - Phone:803-957-1321
Practice Address - Fax:803-957-1356
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist