Provider Demographics
NPI:1710695507
Name:MAHKOVTZ, JOSHUA JAROD
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JAROD
Last Name:MAHKOVTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 CREEKSIDE FARMS WAY
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-4500
Mailing Address - Country:US
Mailing Address - Phone:864-572-9662
Mailing Address - Fax:
Practice Address - Street 1:101 W WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1651
Practice Address - Country:US
Practice Address - Phone:864-879-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31502183500000X
SC43746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist