MEDICARE: MR. JEFFREY LEE BARKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	8302	SC

General Provider Information

NPI Number	:	1386989879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY LEE BARKER

Provider Business Mailing Address
First Line	:	655 FAIRVIEW RD STE C
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29680-6777
Country	:	US
Telephone Number	:	864-962-0251
Fax Number	:	864-963-7579

Provider Business Practice Location Address
First Line	:	655 FAIRVIEW RD STE C
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29680-6777
Country	:	US
Telephone Number	:	864-962-0251
Fax Number	:	864-963-7579

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	12/10/2012

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