Organization
WALL DRUGS OF JOHNSONVILLE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERRICK ALLAN WALL RPH (OWNER RPH)
(843) 386-6135
Entity
Organization
Contact information
Practice address
239 STUCKEY STREET, JOHNSONVILLE, SC 29555
(843) 386-6135
(843) 380-1025
Mailing address
239 STUCKEY ST, JOHNSONVILLE, SC 29555-6448
(843) 386-6135
(843) 380-1025
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
50006733
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4224274
NABP # NCPDP
—
05
—
767338
—
SC
Enumeration date
09/27/2006
Last updated
02/12/2021
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