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General NPI Number Information
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NPI Number | 1710616610
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Entity Type | Individual
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Provider Name | MADISON L WOLTERS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 109 BEE ST
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City | CHARLESTON
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State | SC
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Zip | 29401-5703
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Country | US
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Telephone | 218-205-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 274 FLEMING RD APT B
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City | CHARLESTON
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State | SC
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Zip | 29412-2464
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Country | US
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Telephone |
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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 | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | 21209-40
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | P9535
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License Number State | ID
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