MEDICARE: DR. JOLI D FERMO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	8921	SC

General Provider Information

NPI Number	:	1063027456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOLI D FERMO PHARMD

Provider Business Mailing Address
First Line	:	266 N SHELMORE BLVD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-6609
Country	:	US
Telephone Number	:	843-442-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 CALHOUN ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8906
Country	:	US
Telephone Number	:	843-876-2982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	09/11/2020

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