Individual
MRS. PHYLLIS MATTOX SHOOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
6439 GARNERS FERRY RD, COLUMBIA, SC 29209-1638
(803) 776-4000
(803) 695-6747
Mailing address
817 MOUNT VALLEY RD, BLYTHEWOOD, SC 29016-7772
(803) 714-9180
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
005844
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SC5844
PHARMACY LICENSE
SC
Enumeration date
08/13/2006
Last updated
07/08/2007
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