Healthcare Provider Details

I. General information

NPI: 1619012697
Provider Name (Legal Business Name): HAROLD R WAYNICK JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MAIN STREET
SUMMERTON SC
29148
US

IV. Provider business mailing address

340 LAKEWOOD DRIVE
SUMTER SC
29150
US

V. Phone/Fax

Practice location:
  • Phone: 803-485-8725
  • Fax: 803-485-4306
Mailing address:
  • Phone: 803-481-7498
  • Fax: 803-485-4306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number004006
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: