=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639742364
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELYN MARIE SHYTLE PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2021
-----------------------------------------------------
Last Update Date | 05/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1225 CHERRY RD
-----------------------------------------------------
City | ROCK HILL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29732-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-324-1260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1084 CHAMBERS RD
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29745-9621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-575-1211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 42970
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------