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General NPI Number Information
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NPI Number | 1538786769
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Entity Type | Individual
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Provider Name | JORDAN A DIMOCK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/03/2020
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Last Update Date | 07/03/2020
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Provider Practice Location Address
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Address Line | 2401 SUNSET BLVD
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4717
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Country | US
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Telephone | 803-796-8126
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Fax |
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Provider Business Mailing Address
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Address Line | 105 AMBERWOOD CIR
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City | IRMO
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State | SC
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Zip | 29063-7943
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Country | US
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Telephone | 803-528-3054
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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 | 42496
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License Number State | SC
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