Provider Demographics
NPI:1770902561
Name:WAYMER, MAVIS (RPH)
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:WAYMER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-5401
Mailing Address - Country:US
Mailing Address - Phone:803-782-8428
Mailing Address - Fax:803-782-1726
Practice Address - Street 1:5420 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-5401
Practice Address - Country:US
Practice Address - Phone:803-782-8428
Practice Address - Fax:803-782-1726
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist