Provider Demographics
NPI:1558612564
Name:METTS, BEVIN WHITMAN
Entity Type:Individual
Prefix:
First Name:BEVIN
Middle Name:WHITMAN
Last Name:METTS
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 1:454 BERRYHILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-6447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4079 AUGUSTA HWY STE A
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:SC
Practice Address - Zip Code:29054-8322
Practice Address - Country:US
Practice Address - Phone:803-756-4175
Practice Address - Fax:803-756-4178
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist