Provider Demographics
NPI:1104141605
Name:PROFESSIONAL HEALTH CONSULTANTS
Entity type:Organization
Organization Name:PROFESSIONAL HEALTH CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:BLANTON
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-267-9583
Mailing Address - Street 1:401 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 6TH AVE S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3305
Practice Address - Country:US
Practice Address - Phone:843-267-9583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty