Provider Demographics
NPI:1598036147
Name:FENDER, DENA CRIBB (RPH)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:CRIBB
Last Name:FENDER
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 1:2055 WEDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-4654
Mailing Address - Country:US
Mailing Address - Phone:803-938-9926
Mailing Address - Fax:803-773-6088
Practice Address - Street 1:2055 WEDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-4654
Practice Address - Country:US
Practice Address - Phone:803-938-9926
Practice Address - Fax:803-773-6088
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist