Healthcare Provider Details

I. General information

NPI: 1528033255
Provider Name (Legal Business Name): ROBERT E HUNTLEY JR. B.S. PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MONCRIEF ARMY COMMUNITY HOSPITAL 4500 STUART ST
FT JACKSON SC
29207
US

IV. Provider business mailing address

315 PICKWICK DR
COLUMBIA SC
29223-8248
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-2385
  • Fax: 803-751-0547
Mailing address:
  • Phone: 803-699-9691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number009044
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: