Provider Demographics
NPI:1437449824
Name:MATHIS, JOHN T JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:MATHIS
Suffix:JR
Gender:M
Credentials:PHARMD
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Mailing Address - Street 1:1517 SHIRLEY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1443
Mailing Address - Country:US
Mailing Address - Phone:803-331-1207
Mailing Address - Fax:803-799-8296
Practice Address - Street 1:2708 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-3410
Practice Address - Country:US
Practice Address - Phone:803-799-0036
Practice Address - Fax:803-799-8296
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
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Provider Licenses
StateLicense IDTaxonomies
SC5142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist