Provider Demographics
NPI:1861901886
Name:ZORN, AMY E (RPH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:ZORN
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 1:12935 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:SC
Mailing Address - Zip Code:29853-2321
Mailing Address - Country:US
Mailing Address - Phone:803-266-3356
Mailing Address - Fax:803-266-3358
Practice Address - Street 1:12935 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:SC
Practice Address - Zip Code:29853-2321
Practice Address - Country:US
Practice Address - Phone:803-266-3356
Practice Address - Fax:803-266-3358
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC161973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9165OtherSCBOP