Individual
DR. BRANTLEY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
600 E PALMETTO ST, FLORENCE, SC 29506-2851
(843) 656-0390
Mailing address
600 E PALMETTO ST, FLORENCE, SC 29506-2851
(843) 656-0390
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14353
SC
183500000X
Pharmacist
23771
NC
Other
Enumeration date
03/06/2015
Last updated
03/06/2015
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