Healthcare Provider Details

I. General information

NPI: 1477398105
Provider Name (Legal Business Name): JACOB FISCHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 ASHLEY PHOSPHATE RD
NORTH CHARLESTON SC
29418-2823
US

IV. Provider business mailing address

668 FIRE TOWER RD
NEESES SC
29107-9300
US

V. Phone/Fax

Practice location:
  • Phone: 843-767-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60204
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: