Provider Demographics
NPI:1295070886
Name:FETNER, HARRIET HART (PHARMD)
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:HART
Last Name:FETNER
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 1:625 WHITE FALLS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1239
Mailing Address - Country:US
Mailing Address - Phone:803-781-9666
Mailing Address - Fax:
Practice Address - Street 1:625 WHITE FALLS DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1239
Practice Address - Country:US
Practice Address - Phone:803-781-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC005764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC005764OtherPHARMACIST LICENSE