Provider Demographics
NPI:1306401625
Name:WOLCOTT, KAYLA ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANNE
Last Name:WOLCOTT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:ANNE
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1152 LAKE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MONCRIEF ARMY HOSPITAL OUTPATIENT PHARMACY 1 FT JACKSON
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207
Practice Address - Country:US
Practice Address - Phone:803-751-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0009827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist