Individual
JACK EDWARD WILFONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9600 N KINGS HWY, MYRTLE BEACH, SC 29572-4006
(843) 449-2158
(843) 692-7221
Mailing address
9600 N KINGS HWY, MYRTLE BEACH, SC 29572-4006
(843) 449-2158
(843) 692-7221
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6772
SC
Other
Enumeration date
10/24/2011
Last updated
10/24/2011
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