Provider Demographics
NPI:1902214331
Name:WRIGHT, PETER II
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:WRIGHT
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 PAXVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-6434
Mailing Address - Country:US
Mailing Address - Phone:803-435-4747
Mailing Address - Fax:803-435-4747
Practice Address - Street 1:2010 PAXVILLE HWY
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-6434
Practice Address - Country:US
Practice Address - Phone:803-435-4747
Practice Address - Fax:803-435-4747
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist