Provider Demographics
NPI:1508087131
Name:SPEAS, JODIE LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:LYNN
Last Name:SPEAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:
Other - Last Name:POSTLETHWAIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 ENTERPRISE BLVD.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3593
Mailing Address - Country:US
Mailing Address - Phone:864-454-0810
Mailing Address - Fax:864-454-1130
Practice Address - Street 1:701 GROVE ROAD EMPLOYEE PAVILION
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-1325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC57-6007863OtherTAX ID NUMBER