Provider Demographics
NPI:1912156167
Name:PEE DEE DIABETIC CONSULTANTS,LLC
Entity Type:Organization
Organization Name:PEE DEE DIABETIC CONSULTANTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:DIXON
Authorized Official - Last Name:PLAYER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH/CDE
Authorized Official - Phone:843-394-3121
Mailing Address - Street 1:212 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2102
Mailing Address - Country:US
Mailing Address - Phone:843-394-3121
Mailing Address - Fax:843-394-2551
Practice Address - Street 1:269 N RON MCNAIR BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2437
Practice Address - Country:US
Practice Address - Phone:843-394-3121
Practice Address - Fax:843-394-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty