Provider Demographics
NPI:1942788039
Name:DANIELS, WESLEY HOLLAND (PHARMD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:HOLLAND
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 HIGHWAY 378
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-8316
Mailing Address - Country:US
Mailing Address - Phone:803-996-6171
Mailing Address - Fax:
Practice Address - Street 1:847 HIGHWAY 378
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-8316
Practice Address - Country:US
Practice Address - Phone:803-996-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist