Provider Demographics
NPI:1386983625
Name:WALL, JAMES E (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:WALL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1921
Mailing Address - Country:US
Mailing Address - Phone:864-877-0753
Mailing Address - Fax:864-877-5171
Practice Address - Street 1:109 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1921
Practice Address - Country:US
Practice Address - Phone:864-877-0753
Practice Address - Fax:864-877-5171
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist