Provider Demographics
NPI:1700396827
Name:TWITTY, JIMON
Entity Type:Individual
Prefix:
First Name:JIMON
Middle Name:
Last Name:TWITTY
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 1:7697 CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-9653
Mailing Address - Country:US
Mailing Address - Phone:803-447-4737
Mailing Address - Fax:
Practice Address - Street 1:1000 S CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4046
Practice Address - Country:US
Practice Address - Phone:410-752-9087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist