Provider Demographics
NPI:1114367588
Name:GATES, JESSICA HUTTO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:HUTTO
Last Name:GATES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10204 TWO NOTCH RD
Mailing Address - Street 2:T-1319
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-4386
Mailing Address - Country:US
Mailing Address - Phone:803-788-0951
Mailing Address - Fax:
Practice Address - Street 1:10204 TWO NOTCH RD
Practice Address - Street 2:T-1319
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-4386
Practice Address - Country:US
Practice Address - Phone:803-788-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist