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General NPI Number Information
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NPI Number | 1821302993
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Entity Type | Individual
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Provider Name | JOHNNY JAY HORACE R.PH
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Gender | Male
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Dates
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Enumeration Date | 08/01/2010
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 723 BETHEL ST
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City | CLOVER
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State | SC
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Zip | 29710-1157
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Country | US
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Telephone | 803-222-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 2839 ARROWWOOD LN
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City | ROCK HILL
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State | SC
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Zip | 29732-8444
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Country | US
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Telephone | 803-487-6824
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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 | 4891
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License Number State | SC
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