Provider Demographics
NPI:1639427628
Name:WYNN, RHONDA W (PHARMD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:W
Last Name:WYNN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 HARD SCRABBLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9423
Mailing Address - Country:US
Mailing Address - Phone:803-865-6682
Mailing Address - Fax:803-865-5850
Practice Address - Street 1:4310 HARD SCRABBLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9423
Practice Address - Country:US
Practice Address - Phone:803-865-6682
Practice Address - Fax:803-865-5850
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist