Provider Demographics
NPI:1821302993
Name:HORACE, JOHNNY JAY (RPH)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:JAY
Last Name:HORACE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 ARROWWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8444
Mailing Address - Country:US
Mailing Address - Phone:803-487-6824
Mailing Address - Fax:
Practice Address - Street 1:723 BETHEL ST
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-1157
Practice Address - Country:US
Practice Address - Phone:803-222-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-01
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist