Provider Demographics
NPI:1205176419
Name:HARRELL, ELEANOR JENKINS (RPH)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:JENKINS
Last Name:HARRELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 NELSON BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4025
Mailing Address - Country:US
Mailing Address - Phone:842-354-3373
Mailing Address - Fax:843-354-5695
Practice Address - Street 1:480 NELSON BLVD
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4025
Practice Address - Country:US
Practice Address - Phone:842-354-3373
Practice Address - Fax:843-354-5695
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist