Healthcare Provider Details

I. General information

NPI: 1861499378
Provider Name (Legal Business Name): THOMAS JOHN WORRALL PHARMD, BCACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST RALPH H. JOHNSON VA MEDICAL CENTER
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

800 HIGH BATTERY CIR
MOUNT PLEASANT SC
29464-7879
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-6527
  • Fax: 843-805-5798
Mailing address:
  • Phone: 843-971-4949
  • Fax: 843-805-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number009690
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: