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General NPI Number Information
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NPI Number | 1457663098
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Entity Type | Individual
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Provider Name | LAURA VIRGINIA SALLEY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 5060 INTERNATIONAL BLVD SUITE 102
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City | CHARLESTON
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State | SC
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Zip | 29418-6008
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Country | US
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Telephone | 843-556-7813
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Fax | 843-571-5671
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Provider Business Mailing Address
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Address Line | 5060 INTERNATIONAL BLVD SUITE 102
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City | CHARLESTON
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State | SC
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Zip | 29418-6008
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Country | US
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Telephone | 843-556-7813
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Fax | 843-571-5671
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21054
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License Number State | NC
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