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Individual

MARISSA WALLIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
1080 ALICE DR, SUMTER, SC 29150-2463
(803) 778-0460
Mailing address
239 KEELS RD, SUMTER, SC 29154-4619

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
42095
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
42095
PHARMACY
SC
Enumeration date
08/27/2019
Last updated
08/27/2019
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