Healthcare Provider Details

I. General information

NPI: 1013838903
Provider Name (Legal Business Name): MELANIE WYSONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 HIGHWAY 41
MOUNT PLEASANT SC
29466-6200
US

IV. Provider business mailing address

1008 ARUBA CIR
CHARLESTON SC
29412-8641
US

V. Phone/Fax

Practice location:
  • Phone: 843-971-2075
  • Fax:
Mailing address:
  • Phone: 513-319-8029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67890
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: