MEDICARE: MR. DONNIE ALAN WINGARD JR. R.PH.

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	7456	SC

General Provider Information

NPI Number	:	1487012324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONNIE ALAN WINGARD JR. R.PH.

Provider Business Mailing Address
First Line	:	3630 COASTAL CRAB RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-8368
Country	:	US
Telephone Number	:	843-327-5056
Fax Number	:

Provider Business Practice Location Address
First Line	:	3630 COASTAL CRAB RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-8368
Country	:	US
Telephone Number	:	843-327-5056
Fax Number	:

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

Provider Enumeration Date	:	02/07/2016
Last Update Date	:	02/07/2016

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