Provider Demographics
NPI:1962009928
Name:DWYER, LAURIE M (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:M
Last Name:DWYER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-1617
Mailing Address - Country:US
Mailing Address - Phone:843-752-0023
Mailing Address - Fax:843-752-0062
Practice Address - Street 1:106 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1617
Practice Address - Country:US
Practice Address - Phone:843-752-0023
Practice Address - Fax:843-752-0079
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC71011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty