Provider Demographics
NPI:1376632802
Name:SAUTER, JIM W (RPH)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:W
Last Name:SAUTER
Suffix:
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 1:167 BLUFFTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6228
Mailing Address - Country:US
Mailing Address - Phone:843-757-4999
Mailing Address - Fax:
Practice Address - Street 1:167 BLUFFTON RD STE B
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6228
Practice Address - Country:US
Practice Address - Phone:843-757-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC724671Medicaid