Provider Demographics
NPI:1639540602
Name:WITHERSPOON, CHELSEY MOZINGO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHELSEY
Middle Name:MOZINGO
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 GARDEN CITY CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7847
Mailing Address - Country:US
Mailing Address - Phone:843-357-6588
Mailing Address - Fax:843-357-6591
Practice Address - Street 1:545 GARDEN CITY CONNECTOR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7847
Practice Address - Country:US
Practice Address - Phone:843-357-6588
Practice Address - Fax:843-357-6591
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist