Provider Demographics
NPI:1821390238
Name:KULCHUK, JONATHAN RAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RAY
Last Name:KULCHUK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3285 RICHARDS XING
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8910
Mailing Address - Country:US
Mailing Address - Phone:843-302-2210
Mailing Address - Fax:
Practice Address - Street 1:2907 HIGHWAY 160 W
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8491
Practice Address - Country:US
Practice Address - Phone:803-548-6495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist