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General NPI Number Information
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NPI Number | 1477153666
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Entity Type | Individual
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Provider Name | JEREMY HARGIS
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Gender | Male
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 5303A WRIGHTSBORO RD
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City | GROVETOWN
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State | GA
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Zip | 30813-2800
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Country | US
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Telephone | 762-383-6527
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Fax | 762-383-6526
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Provider Business Mailing Address
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Address Line | 216 OAKHURST DR
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City | NORTH AUGUSTA
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State | SC
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Zip | 29860-9718
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Country | US
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Telephone | 803-624-0620
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Fax |
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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 | RPH031249
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License Number State | GA
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