Provider Demographics
NPI:1912202151
Name:FUNDERBURK, JANET ROSE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:ROSE
Last Name:FUNDERBURK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-3805
Mailing Address - Country:US
Mailing Address - Phone:803-285-8491
Mailing Address - Fax:803-285-7263
Practice Address - Street 1:1728 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-3805
Practice Address - Country:US
Practice Address - Phone:803-285-8491
Practice Address - Fax:803-285-7263
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6779183500000X
NC12026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist