Provider Demographics
NPI:1962491332
Name:STOVER, BETTIE BERNARD
Entity type:Individual
Prefix:
First Name:BETTIE
Middle Name:BERNARD
Last Name:STOVER
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 1:2400 CLEMATIS TRL
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2312
Mailing Address - Country:US
Mailing Address - Phone:803-469-0784
Mailing Address - Fax:
Practice Address - Street 1:35 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-5240
Practice Address - Country:US
Practice Address - Phone:803-773-7283
Practice Address - Fax:803-775-7908
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist