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NPI Code Detail

MEDICARE: SHAMAI AVIONA WYATT

MEDICARE: SHAMAI AVIONA WYATT
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
1183500000XPharmacist44041SC

General Provider Information

NPI Number : 1487437810
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAMAI AVIONA WYATT
Provider Business Mailing Address
First Line : 1410 PARAPET FORT DR APT 104
Second Line :
City : DUNCAN
State : SC
Zip : 29334-7625
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3681 BOILING SPRINGS RD
Second Line :
City : BOILING SPRINGS
State : SC
Zip : 29316-6021
Country : US
Telephone Number : 864-578-2414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2023
Last Update Date : 08/17/2023

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Directions to “ SHAMAI AVIONA WYATT ” Practice Location

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