Healthcare Provider Details

I. General information

NPI: 1023158367
Provider Name (Legal Business Name): JERRY L SMITH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E MAIN ST
WESTMINSTER SC
29693-1753
US

IV. Provider business mailing address

319 ANDERSON AVE
WESTMINSTER SC
29693-1407
US

V. Phone/Fax

Practice location:
  • Phone: 864-647-5941
  • Fax: 864-647-2906
Mailing address:
  • Phone: 864-647-5941
  • Fax: 864-647-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number004163
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: