Provider Demographics
NPI:1215615216
Name:WISE, DANIELLE LATRICE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:LATRICE
Last Name:WISE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 MAGGIE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-9209
Mailing Address - Country:US
Mailing Address - Phone:843-640-1197
Mailing Address - Fax:
Practice Address - Street 1:3471 W MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-5938
Practice Address - Country:US
Practice Address - Phone:843-531-5187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist