Provider Demographics
NPI:1386952430
Name:SAMS, KELLY C (RPH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:SAMS
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 1:1440 BEN SAWYER BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5525
Mailing Address - Country:US
Mailing Address - Phone:843-388-2504
Mailing Address - Fax:843-856-0574
Practice Address - Street 1:1440 BEN SAWYER BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5525
Practice Address - Country:US
Practice Address - Phone:843-388-2504
Practice Address - Fax:843-856-0574
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist