Provider Demographics
NPI:1265169718
Name:VANDIVER, MARIANNE ELIZABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:ELIZABETH
Last Name:VANDIVER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-4949
Mailing Address - Country:US
Mailing Address - Phone:864-356-5580
Mailing Address - Fax:
Practice Address - Street 1:3405 WHITE HORSE RD STE F
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-5947
Practice Address - Country:US
Practice Address - Phone:864-671-0300
Practice Address - Fax:864-671-0301
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist