Individual
KASEY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
207 W BUTLER RD, MAULDIN, SC 29662-2536
(864) 458-8907
Mailing address
503 PEDEN RD, FOUNTAIN INN, SC 29644-9123
(864) 915-8733
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
36230
SC
Other
Enumeration date
07/22/2015
Last updated
07/22/2015
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