Provider Demographics
NPI:1609476985
Name:POLK, PAMELA PAGE (RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:PAGE
Last Name:POLK
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 1:117 COLUMBINE WAY
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29635-9531
Mailing Address - Country:US
Mailing Address - Phone:843-270-7862
Mailing Address - Fax:
Practice Address - Street 1:200 FLEETWOOD DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2022
Practice Address - Country:US
Practice Address - Phone:864-442-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPH9474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist