Provider Demographics
NPI:1700557105
Name:BLOCKER, MARY JANE (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:BLOCKER
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 1:541 PINE TOP RD
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-7637
Mailing Address - Country:US
Mailing Address - Phone:843-458-0386
Mailing Address - Fax:
Practice Address - Street 1:541 PINE TOP RD
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7637
Practice Address - Country:US
Practice Address - Phone:843-458-0386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist