Provider Demographics
NPI:1114079258
Name:ISREAL, GERALD JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:ISREAL
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BUCKTHORN CIR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8699
Mailing Address - Country:US
Mailing Address - Phone:803-788-8940
Mailing Address - Fax:803-788-8568
Practice Address - Street 1:210 BUCKTHORN CIR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8699
Practice Address - Country:US
Practice Address - Phone:803-788-8940
Practice Address - Fax:803-788-8568
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist