Provider Demographics
NPI:1184960239
Name:WALDREP, LEWIS DARWIN (RPH)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:DARWIN
Last Name:WALDREP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 OCEAN HWY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-7585
Mailing Address - Country:US
Mailing Address - Phone:803-235-0580
Mailing Address - Fax:
Practice Address - Street 1:9710 OCEAN HWY UNIT 2
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7585
Practice Address - Country:US
Practice Address - Phone:803-235-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist