Provider Demographics
NPI:1760926224
Name:PRICE, PAMELA (IBCLC, LPN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:IBCLC, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4443 BORROW PIT RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29449-5991
Mailing Address - Country:US
Mailing Address - Phone:843-209-3477
Mailing Address - Fax:
Practice Address - Street 1:4443 BORROW PIT RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:SC
Practice Address - Zip Code:29449-5991
Practice Address - Country:US
Practice Address - Phone:843-209-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC102-18619174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC102-18619OtherIBCLE