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VANCE TIMOTHY WALL R.PH.

>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1518141753

Individual Registrant:
 VANCE TIMOTHY WALL R.PH.
Gender: M
Sole Proprietor

Location and contact information for practice:
2820 AUGUSTA ROAD  LANGLEY, SC 29834 US
Tel: 803-593-3411  Fax: 803-593-6090

Contact information for business:
PO BOX 1860  LANGLEY, SC 29834-1860 US
Tel: 803-593-3411  Fax: 866-838-0951

Registration Information:
NPI: 1518141753
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
Pharmacist
SC4236

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
STATE PHARMACY LICENSE13303GA01
STATE PHARMACY LICENSE4236SC01




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