Healthcare Provider Details

I. General information

NPI: 1861312746
Provider Name (Legal Business Name): JACKSON THOMAS REDICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 ASHLEY TOWN CENTER DR
CHARLESTON SC
29414-5664
US

IV. Provider business mailing address

3050 ASHLEY TOWN CENTER DR
CHARLESTON SC
29414-5664
US

V. Phone/Fax

Practice location:
  • Phone: 843-460-2002
  • Fax: 843-460-2020
Mailing address:
  • Phone: 843-460-2002
  • Fax: 843-460-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67829
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: