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General NPI Number Information
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NPI Number | 1710695507
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Entity Type | Individual
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Provider Name | JOSHUA JAROD MAHKOVTZ
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Gender | Male
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 101 W WADE HAMPTON BLVD
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City | GREER
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State | SC
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Zip | 29650-1651
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Country | US
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Telephone | 864-879-1949
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Fax |
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Provider Business Mailing Address
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Address Line | 233 CREEKSIDE FARMS WAY
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City | DUNCAN
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State | SC
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Zip | 29334-4500
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Country | US
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Telephone | 864-572-9662
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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 | 31502
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License Number State | NC
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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 | 43746
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License Number State | SC
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