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General NPI Number Information
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NPI Number | 1932760071
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Entity Type | Individual
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Provider Name | JONATHAN BLACKWOOD PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 1355 KNOX ABBOTT DR
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City | CAYCE
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State | SC
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Zip | 29033-3327
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Country | US
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Telephone | 803-223-0762
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Fax |
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Provider Business Mailing Address
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Address Line | 104 ELIZA LN
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City | MARIETTA
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State | SC
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Zip | 29661-9074
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Country | US
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Telephone |
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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 | 41958
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License Number State | SC
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