Provider Demographics
NPI:1457663098
Name:SALLEY, LAURA VIRGINIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:VIRGINIA
Last Name:SALLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5060 INTERNATIONAL BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-6008
Mailing Address - Country:US
Mailing Address - Phone:843-556-7813
Mailing Address - Fax:843-571-5671
Practice Address - Street 1:5060 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6008
Practice Address - Country:US
Practice Address - Phone:843-556-7813
Practice Address - Fax:843-571-5671
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist