Individual
TIMOTHY VANNATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
626 BACONS BRIDGE RD, SUMMERVILLE, SC 29485-4102
(843) 873-5830
(843) 873-8742
Mailing address
626 BACONS BRIDGE RD, SUMMERVILLE, SC 29485-4102
(843) 873-5830
(843) 873-8742
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051036205
IL
183500000X
Pharmacist
320
VI
183500000X
Pharmacist
Primary
39501
SC
Other
Enumeration date
03/17/2016
Last updated
03/17/2016
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