Provider Demographics
NPI:1629365796
Name:POWELL, JUNIOUS KEITH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUNIOUS
Middle Name:KEITH
Last Name:POWELL
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 1:5900 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6227
Mailing Address - Country:US
Mailing Address - Phone:803-691-1690
Mailing Address - Fax:803-749-3763
Practice Address - Street 1:5900 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6227
Practice Address - Country:US
Practice Address - Phone:803-691-1690
Practice Address - Fax:803-749-3763
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist