Healthcare Provider Details

I. General information

NPI: 1083137079
Provider Name (Legal Business Name): JACOB SCOTT HEFNER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 SYCAMORE AVE
CHARLESTON SC
29407-6774
US

IV. Provider business mailing address

65 SYCAMORE AVE
CHARLESTON SC
29407-6774
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-4461
  • Fax:
Mailing address:
  • Phone: 614-561-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37248
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: