Provider Demographics
NPI:1245650167
Name:WILLIS, JANICE (RPH)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 BULOW POINT RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-7910
Mailing Address - Country:US
Mailing Address - Phone:843-556-3291
Mailing Address - Fax:
Practice Address - Street 1:605 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2758
Practice Address - Country:US
Practice Address - Phone:843-553-3185
Practice Address - Fax:843-553-8337
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist