Organization
WALL DRUGS OF JOHNSONVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALLAN DERRICK WALL (PHARMACISTS)
(843) 386-6135
Entity
Organization
Contact information
Practice address
239 EAST STUCKEY STREET, JOHNSONVILLE, SC 29555-0545
(843) 380-1066
Mailing address
239 EAST STUCKEY STR., JOHNSONVILLE, SC 29555-0545
(843) 380-1066
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
50006733
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4224274
NABP
SC
01
—
50006733
PHARMACY
SC
05
—
767338
—
SC
Enumeration date
06/22/2007
Last updated
08/22/2020
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