Individual
SHIVA SHILA TAVASSOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 LOCUST ST, LYMAN, SC 29365
(864) 439-1040
Mailing address
119 AMBER LEAF DR, GAFFNEY, SC 29341-3552
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
37774
SC
Other
Enumeration date
07/15/2018
Last updated
07/15/2018
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