Individual
MR. DERRICK ALLAN WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
239 STUCKEY ST, JOHNSONVILLE, SC 29555
(843) 386-6135
(843) 380-1025
Mailing address
PO BOX 947, JOHNSONVILLE, SC 29555
(843) 933-0080
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9429
SC
Other
Enumeration date
09/27/2006
Last updated
09/21/2016
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