Provider Demographics
NPI:1063787547
Name:PACE, AVERITTE BURNEY JR (PHARMACY BS)
Entity type:Individual
Prefix:MR
First Name:AVERITTE
Middle Name:BURNEY
Last Name:PACE
Suffix:JR
Gender:M
Credentials:PHARMACY BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:401 SOUTH NICHOLS STREET
Mailing Address - City:NICHOLS
Mailing Address - State:SC
Mailing Address - Zip Code:29581-0207
Mailing Address - Country:US
Mailing Address - Phone:843-526-2257
Mailing Address - Fax:843-526-1705
Practice Address - Street 1:116 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NICHOLS
Practice Address - State:SC
Practice Address - Zip Code:29581-0207
Practice Address - Country:US
Practice Address - Phone:843-526-2171
Practice Address - Fax:843-526-1705
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3526OtherPHARMACIST