=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972965101
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGHAN DICKEY JAHNKE PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2016
-----------------------------------------------------
Last Update Date | 03/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 820 N MAIN ST
-----------------------------------------------------
City | WOODRUFF
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29388-9001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-476-0463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 MUSGROVE ST APT 103
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29325-1780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-214-0574
-----------------------------------------------------
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 | 36472
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------