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General NPI Number Information
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NPI Number | 1437653441
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Entity Type | Organization
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Legal Business Name | MEDICINE MART COLUMBIA, INC.
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 3729 ROSEWOOD DR
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City | COLUMBIA
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State | SC
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Zip | 29205-3531
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Country | US
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Telephone | 803-231-2003
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Fax | 803-231-2003
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Provider Business Mailing Address
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Address Line | 3729 ROSEWOOD DR
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City | COLUMBIA
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State | SC
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Zip | 29205-3531
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Country | US
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Telephone | 803-231-2003
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Fax | 803-231-2003
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW D WALL
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Credential | PHARMD
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Telephone | 803-231-2003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | SC
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