Provider Demographics
NPI:1124497920
Name:WRIGHTENBERRY, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WRIGHTENBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2188
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-2636
Mailing Address - Country:US
Mailing Address - Phone:843-726-5444
Mailing Address - Fax:843-726-6653
Practice Address - Street 1:7752 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-6362
Practice Address - Country:US
Practice Address - Phone:843-726-5444
Practice Address - Fax:843-726-6653
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist