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General NPI Number Information
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NPI Number | 1417350059
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Entity Type | Individual
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Provider Name | JESSICA MARIE FAVALORA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 705 ELM ST W
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City | HAMPTON
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State | SC
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Zip | 29924-3105
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Country | US
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Telephone | 803-943-4446
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Fax |
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Provider Business Mailing Address
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Address Line | 4301 WILSON ST
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City | FORT SILL
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State | OK
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Zip | 73503-4472
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Country | US
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Telephone | 843-469-2829
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Fax | 580-558-2445
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 35695
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License Number State | SC
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