Provider Demographics
NPI:1639586027
Name:TOLLE, ALYSSA GRAHAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:GRAHAM
Last Name:TOLLE
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 1:608 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3823
Mailing Address - Country:US
Mailing Address - Phone:803-260-7775
Mailing Address - Fax:
Practice Address - Street 1:1941 BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2217
Practice Address - Country:US
Practice Address - Phone:803-212-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist