Healthcare Provider Details

I. General information

NPI: 1659859957
Provider Name (Legal Business Name): MARTIN JON GUZIOR III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CLEMSON RD
COLUMBIA SC
29229-6545
US

IV. Provider business mailing address

121 CLEMSON RD
COLUMBIA SC
29229-6545
US

V. Phone/Fax

Practice location:
  • Phone: 803-419-4002
  • Fax:
Mailing address:
  • Phone: 803-419-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37824
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: