Provider Demographics
NPI:1790034437
Name:DEHOLCZER, ADENA
Entity Type:Individual
Prefix:MRS
First Name:ADENA
Middle Name:
Last Name:DEHOLCZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 FOREST DR STE 5
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-3125
Mailing Address - Country:US
Mailing Address - Phone:803-787-0186
Mailing Address - Fax:803-787-7837
Practice Address - Street 1:4711 FOREST DR STE 5
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-3125
Practice Address - Country:US
Practice Address - Phone:803-787-0186
Practice Address - Fax:803-787-7837
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist