Provider Demographics
NPI:1245641703
Name:MATHIS, JAMES VICTOR JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VICTOR
Last Name:MATHIS
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12 N BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3206
Mailing Address - Country:US
Mailing Address - Phone:803-435-2511
Mailing Address - Fax:803-435-4235
Practice Address - Street 1:12 N BROOKS ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3206
Practice Address - Country:US
Practice Address - Phone:803-435-2511
Practice Address - Fax:803-435-4235
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-17
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC11113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist