Organization
WELVISTA
Active
Other names
WELVISTA
Organization subpart
No
Provider details
NPI number
Authorized official
JUANITA WRIGHT (CHIEF EXECUTIVE OFFICER)
(803) 933-9183
Entity
Organization
Contact information
Practice address
2700 MIDDLEBURG DR STE 108, COLUMBIA, SC 29204-2416
(803) 933-9183
(803) 254-0892
Mailing address
2700 MIDDLEBURG DR STE 108, COLUMBIA, SC 29204-2416
(803) 933-9183
(803) 254-0892
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
10219
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2093414
PK
—
05
—
710219
—
SC
Enumeration date
08/10/2007
Last updated
06/03/2015
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