Provider Demographics
NPI:1518355346
Name:GLADFELDER, JAMIE (RPH)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:GLADFELDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TIGER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2664
Mailing Address - Country:US
Mailing Address - Phone:864-653-7962
Mailing Address - Fax:
Practice Address - Street 1:1100 TIGER BLVD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2664
Practice Address - Country:US
Practice Address - Phone:864-653-7962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist