Provider Demographics
NPI:1366047524
Name:KIRBY, PAMELA HORTON (RPH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:HORTON
Last Name:KIRBY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CVS
Mailing Address - Street 2:301 WEST THOMAS STREET
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560
Mailing Address - Country:US
Mailing Address - Phone:843-394-5434
Mailing Address - Fax:843-394-3654
Practice Address - Street 1:CVS
Practice Address - Street 2:301 WEST THOMAS STREET
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560
Practice Address - Country:US
Practice Address - Phone:843-394-5434
Practice Address - Fax:843-394-3654
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist