Provider Demographics
NPI:1700432218
Name:NETHERCOTT, AARON ROBERT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:ROBERT
Last Name:NETHERCOTT
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 1:148 WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:IVA
Mailing Address - State:SC
Mailing Address - Zip Code:29655-8671
Mailing Address - Country:US
Mailing Address - Phone:208-351-5822
Mailing Address - Fax:
Practice Address - Street 1:1041 YORK ST NE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4025
Practice Address - Country:US
Practice Address - Phone:803-649-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27393183500000X
MO2016027739183500000X
SC41941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist