Derrick Allan Wall, RPH
Individual provider Active NPI Pharmacist · Johnsonville, SC
NPI 1124119342 · NPPES record last updated Sep 21, 2016
Key facts
- NPI
- 1124119342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 9429 (SC)
- Practice address
- 239 Stuckey St
Johnsonville, SC 29555 - Phone
- (843) 386-6135
- Fax
- (843) 380-1025
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9429 | SC | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wall Drugs of Johnsonville, Inc. | Past |
Accepting new patients | |
| Wall Drugs of Johnsonville | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 9429 | SC | Yes |
Addresses
Primary practice location
239 Stuckey St
Johnsonville, SC 29555
Mailing address
PO Box 947
Johnsonville, SC 29555
Phone (843) 933-0080
Other providers in Johnsonville, SC
- Katelyn Hanna Rogers
- Chandace B Tanner
- Eric Thompkins
- Wall Drugs of Johnsonville
- Wall Drugs of Johnsonville, Inc.
All providers in Johnsonville, SC · Pharmacist in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.