Healthcare Provider Details

I. General information

NPI: 1659678118
Provider Name (Legal Business Name): WILLIAM JAMES SHEALY BS, PHARMD, CDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ELMS CENTER RD
NORTH CHARLESTON SC
29406-9844
US

IV. Provider business mailing address

PO BOX 118008
NORTH CHARLESTON SC
29423-8008
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-7727
  • Fax:
Mailing address:
  • Phone: 843-572-7727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13118
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number21410352
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: