Provider Demographics
NPI:1558647560
Name:FELDER, JESSICA SANDERSON
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SANDERSON
Last Name:FELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10136 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-4389
Mailing Address - Country:US
Mailing Address - Phone:803-788-4141
Mailing Address - Fax:803-699-8868
Practice Address - Street 1:10136 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-4389
Practice Address - Country:US
Practice Address - Phone:803-788-4141
Practice Address - Fax:803-669-8868
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist