Individual
TOMMY L WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
4125 MAIN ST, LORIS, SC 29569-3023
(843) 756-4021
(843) 756-9124
Mailing address
244 CAROLINA DR, LORIS, SC 29569-5334
(843) 756-1017
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
005603
SC
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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