Provider Demographics
NPI:1700331782
Name:QUATTLEBAUM, ANNA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:QUATTLEBAUM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2196 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9456
Mailing Address - Country:US
Mailing Address - Phone:864-486-1779
Mailing Address - Fax:
Practice Address - Street 1:2196 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9456
Practice Address - Country:US
Practice Address - Phone:864-486-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC36797OtherPHARMACIST LICENSE