Provider Demographics
NPI:1134260920
Name:WEEKS, DERRELYN B
Entity type:Individual
Prefix:
First Name:DERRELYN
Middle Name:B
Last Name:WEEKS
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 1:420 EPTING AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4040
Mailing Address - Country:US
Mailing Address - Phone:864-227-6646
Mailing Address - Fax:
Practice Address - Street 1:420 EPTING AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4040
Practice Address - Country:US
Practice Address - Phone:864-227-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC007224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC726806Medicaid
SCBT281214OtherDEA
SC0316920001Medicare ID - Type Unspecified