Provider Demographics
NPI:1265852610
Name:PRICE, JACOB TAYLOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:TAYLOR
Last Name:PRICE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JACOB
Other - Middle Name:TAYLOR
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:508 BYPASS 72 NW
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-1300
Mailing Address - Country:US
Mailing Address - Phone:864-229-6722
Mailing Address - Fax:
Practice Address - Street 1:508 BYPASS 72 NW
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1300
Practice Address - Country:US
Practice Address - Phone:864-229-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist