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NPI Code Detail

MEDICARE: REGINA BRADLEY-WALL PHARMD

MEDICARE: REGINA BRADLEY-WALL 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
1183500000XPharmacist10470SC

General Provider Information

NPI Number : 1346547643
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGINA BRADLEY-WALL PHARMD
Provider Business Mailing Address
First Line : 902 PELHAM RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29615-3639
Country : US
Telephone Number : 864-234-6462
Fax Number : 864-234-6960
Provider Business Practice Location Address
First Line : 902 PELHAM RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29615-3639
Country : US
Telephone Number : 864-234-6462
Fax Number : 864-234-6960
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2011
Last Update Date : 02/22/2011

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Directions to “ REGINA BRADLEY-WALL PHARMD” Practice Location

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