Provider Demographics
NPI:1568819340
Name:VANCE, STEPHANIE CHAYCE
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:CHAYCE
Last Name:VANCE
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 1:1801 HIGHMARKET ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-2613
Mailing Address - Country:US
Mailing Address - Phone:843-546-2568
Mailing Address - Fax:843-546-1373
Practice Address - Street 1:1801 HIGHMARKET ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2613
Practice Address - Country:US
Practice Address - Phone:843-546-2568
Practice Address - Fax:843-546-1373
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC35741OtherPHARMACY LICENSE