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General NPI Number Information
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NPI Number | 1710039359
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Entity Type | Individual
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Provider Name | MR. DAVID WAYNE ANDERSEN
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 129 N WASHINGTON ST
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City | SUMTER
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State | SC
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Zip | 29150-4949
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Country | US
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Telephone | 803-774-8871
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Fax |
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Provider Business Mailing Address
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Address Line | 2306 PARK ST
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City | COLUMBIA
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State | SC
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Zip | 29201-2146
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Country | US
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Telephone | 803-255-0021
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Fax |
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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 | 011157
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10659
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License Number State | CO
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