Provider Demographics
NPI:1710453477
Name:WISE, LAURYN SHIRLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURYN
Middle Name:SHIRLEY
Last Name:WISE
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 1:106 TAYLORS HILL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2377
Mailing Address - Country:US
Mailing Address - Phone:803-730-5146
Mailing Address - Fax:
Practice Address - Street 1:7467 SAINT ANDREWS RD STE 6
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2876
Practice Address - Country:US
Practice Address - Phone:803-732-0426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37856183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist