MEDICARE: DR. DANIELLE LATRICE WISE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	43294	SC

General Provider Information

NPI Number	:	1215615216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE LATRICE WISE PHARMD

Provider Business Mailing Address
First Line	:	467 MAGGIE RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-9209
Country	:	US
Telephone Number	:	843-640-1197
Fax Number	:

Provider Business Practice Location Address
First Line	:	3471 W MONTAGUE AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-5938
Country	:	US
Telephone Number	:	843-531-5187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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