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VANCE TIMOTHY WALL R.PH.
>> Pharmacist >> Pharmacy Service ProvidersRegistrant NPI Number: 1518141753
Individual Registrant: VANCE TIMOTHY WALL R.PH.
Gender: M
Sole Proprietor
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
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
Tel: 803-593-3411 Fax: 866-838-0951
Registration Information:
NPI: 1518141753
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 183500000X | Pharmacy Service Providers Pharmacist | SC | 4236 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| STATE PHARMACY LICENSE | 13303 | GA | 01 |
| STATE PHARMACY LICENSE | 4236 | SC | 01 |
