Provider Demographics
NPI:1912627845
Name:PINKSTON, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PINKSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SEVEN FARMS DR STE C-117
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8001
Mailing Address - Country:US
Mailing Address - Phone:843-810-3741
Mailing Address - Fax:
Practice Address - Street 1:1671 BELLE ISLE AVE STE 110
Practice Address - Street 2:OFFICE M
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8336
Practice Address - Country:US
Practice Address - Phone:854-444-7124
Practice Address - Fax:800-788-4087
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2025-02-12
Deactivation Date:2022-08-31
Deactivation Code:
Reactivation Date:2025-01-29
Provider Licenses
StateLicense IDTaxonomies
SCDE4090335E00000X
SC2822483332BC3200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment