MEDICARE: MRS. JENNIFER BAGBY RPH

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	9765	SC
2	183500000X	Pharmacist	14011	NC

General Provider Information

NPI Number	:	1639427651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER BAGBY RPH

Provider Business Mailing Address
First Line	:	7647 HIGHWAY 76
Second Line	:
City	:	PENDLETON
State	:	SC
Zip	:	29670-9162
Country	:	US
Telephone Number	:	864-646-7553
Fax Number	:	864-646-6184

Provider Business Practice Location Address
First Line	:	7647 HIGHWAY 76
Second Line	:
City	:	PENDLETON
State	:	SC
Zip	:	29670-9162
Country	:	US
Telephone Number	:	864-646-7553
Fax Number	:	864-646-6184

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

Provider Enumeration Date	:	08/23/2012
Last Update Date	:	08/23/2012

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