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General NPI Number Information
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NPI Number | 1669779682
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Entity Type | Individual
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Provider Name | JESSICA PUCKETT-BEASLEY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 107 WESTPARK BLVD
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City | COLUMBIA
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State | SC
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Zip | 29210-3871
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Country | US
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Telephone | 803-772-4809
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Fax |
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Provider Business Mailing Address
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Address Line | 1116 SILVER POINT RD
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City | CHAPIN
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State | SC
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Zip | 29036-7903
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Country | US
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Telephone | 843-860-4493
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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 | 10477
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 018810
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License Number State | GA
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