Healthcare Provider Details

I. General information

NPI: 1457663098
Provider Name (Legal Business Name): LAURA VIRGINIA SALLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 INTERNATIONAL BLVD SUITE 102
CHARLESTON SC
29418-6008
US

IV. Provider business mailing address

5060 INTERNATIONAL BLVD SUITE 102
CHARLESTON SC
29418-6008
US

V. Phone/Fax

Practice location:
  • Phone: 843-556-7813
  • Fax: 843-571-5671
Mailing address:
  • Phone: 843-556-7813
  • Fax: 843-571-5671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21054
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: