Provider Demographics
NPI:1720367741
Name:THOMAS, JESSICA HORTON (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:HORTON
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1371
Mailing Address - Country:US
Mailing Address - Phone:843-805-6022
Mailing Address - Fax:843-805-5909
Practice Address - Street 1:261 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1371
Practice Address - Country:US
Practice Address - Phone:843-805-6022
Practice Address - Fax:843-805-5909
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist