Healthcare Provider Details

I. General information

NPI: 1700183845
Provider Name (Legal Business Name): KELLI REEVES WIMBERLY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 GROVE PARK DR # DE
ORANGEBURG SC
29115-2455
US

IV. Provider business mailing address

1324 GROVE PARK DR
ORANGEBURG SC
29115-2455
US

V. Phone/Fax

Practice location:
  • Phone: 803-536-0007
  • Fax: 803-531-1800
Mailing address:
  • Phone: 803-536-0007
  • Fax: 803-531-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13112
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: