Provider Demographics
NPI:1770199259
Name:VANDEVENTER, ALEXANDRA DENTON (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DENTON
Last Name:VANDEVENTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:ELIZABETH
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:650 JOHNNIE DODDS BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3013
Mailing Address - Country:US
Mailing Address - Phone:843-849-3471
Mailing Address - Fax:
Practice Address - Street 1:650 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3013
Practice Address - Country:US
Practice Address - Phone:843-849-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-20
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist