Provider Demographics
NPI:1750687489
Name:STULL, EDITH ANN (RPH)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:ANN
Last Name:STULL
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 1:307 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-2305
Mailing Address - Country:US
Mailing Address - Phone:864-938-3857
Mailing Address - Fax:864-938-3903
Practice Address - Street 1:307 N BROAD ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2305
Practice Address - Country:US
Practice Address - Phone:864-938-3857
Practice Address - Fax:864-938-3903
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist