MEDICARE: LISA WHIGHAM PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10666	SC
2	183500000X	Pharmacist	E-9507	MS

General Provider Information

NPI Number	:	1255638219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA WHIGHAM PHARMD

Provider Business Mailing Address
First Line	:	1223 SAINT ANDREWS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5821
Country	:	US
Telephone Number	:	803-731-5120
Fax Number	:	803-731-5194

Provider Business Practice Location Address
First Line	:	1223 SAINT ANDREWS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5821
Country	:	US
Telephone Number	:	803-731-5120
Fax Number	:	803-731-5194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2011
Last Update Date	:	02/27/2011

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Directions to “ LISA WHIGHAM PHARMD” Practice Location

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