Provider Demographics
NPI:1366659096
Name:CHILES, WENDY RENE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:RENE
Last Name:CHILES
Suffix:
Gender:F
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 1:8 CHALFONT CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7393
Mailing Address - Country:US
Mailing Address - Phone:803-788-7953
Mailing Address - Fax:
Practice Address - Street 1:1426 MAIN ST
Practice Address - Street 2:MC 11P
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-5804
Practice Address - Country:US
Practice Address - Phone:803-217-9173
Practice Address - Fax:803-217-9717
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0010124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist