Provider Demographics
NPI:1699024786
Name:DAVIS, JANE SMITH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:SMITH
Last Name:DAVIS
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 1:408B EAST GREER ST
Mailing Address - Street 2:
Mailing Address - City:HONEA PATH
Mailing Address - State:SC
Mailing Address - Zip Code:29654
Mailing Address - Country:US
Mailing Address - Phone:864-369-2822
Mailing Address - Fax:864-369-2536
Practice Address - Street 1:408B EAST GREER ST
Practice Address - Street 2:
Practice Address - City:HONEA PATH
Practice Address - State:SC
Practice Address - Zip Code:29654
Practice Address - Country:US
Practice Address - Phone:864-369-2822
Practice Address - Fax:864-369-2536
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist