Provider Demographics
NPI:1376804146
Name:MCFALL, JONATHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:MCFALL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 CLEMSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8034
Mailing Address - Country:US
Mailing Address - Phone:803-678-4887
Mailing Address - Fax:
Practice Address - Street 1:4500 STUART ST
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:FORT JACKSON
Practice Address - State:SC
Practice Address - Zip Code:29207-8034
Practice Address - Country:US
Practice Address - Phone:803-751-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist