Provider Demographics
NPI:1174639397
Name:WISE, CHARLES WAYNE JR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WAYNE
Last Name:WISE
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1184
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-1184
Mailing Address - Country:US
Mailing Address - Phone:843-765-3320
Mailing Address - Fax:
Practice Address - Street 1:2537B E HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-6347
Practice Address - Country:US
Practice Address - Phone:843-765-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist