Provider Demographics
NPI:1750427985
Name:MUNDIE, DEBRA SHOWALTER (RPH)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:SHOWALTER
Last Name:MUNDIE
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 1:2615 SARASOTA ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-4740
Mailing Address - Country:US
Mailing Address - Phone:843-444-1080
Mailing Address - Fax:
Practice Address - Street 1:3381 PHILLIS BOULEVARD
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS PRIMARY CARE CLINIC
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-477-0177
Practice Address - Fax:843-232-2428
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist