Individual
LINDA FONVIELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2701 DICK POND RD, SURFSIDE BEACH, SC 29575-5510
(843) 650-6800
(843) 215-6155
Mailing address
282 PINEWOOD ST, GEORGETOWN, SC 29440-5852
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
8450
SC
Other
Enumeration date
07/01/2010
Last updated
07/01/2010
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