Provider Demographics
NPI:1568604056
Name:WALL, MEGAN ROWE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ROWE
Last Name:WALL
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:CHESNEE
Mailing Address - State:SC
Mailing Address - Zip Code:29323-1502
Mailing Address - Country:US
Mailing Address - Phone:864-461-2314
Mailing Address - Fax:864-461-5384
Practice Address - Street 1:102 S ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:CHESNEE
Practice Address - State:SC
Practice Address - Zip Code:29323-1502
Practice Address - Country:US
Practice Address - Phone:864-461-2314
Practice Address - Fax:864-461-5384
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16126183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC16126OtherSC BOARD OF PHARMACY