Provider Demographics
NPI:1508612342
Name:JESSUP, ELIZABETH SALLEZ
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SALLEZ
Last Name:JESSUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 OAK POINT LANDING DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6286
Mailing Address - Country:US
Mailing Address - Phone:843-906-2317
Mailing Address - Fax:
Practice Address - Street 1:2301 COSGROVE AVE STE F
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7663
Practice Address - Country:US
Practice Address - Phone:843-529-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist