Provider Demographics
NPI:1770603227
Name:JONES, SAMMYETTE WILSON (RPH)
Entity type:Individual
Prefix:
First Name:SAMMYETTE
Middle Name:WILSON
Last Name:JONES
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 1:5900 MAIN ST
Mailing Address - Street 2:ECKERD PHARMACY
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6227
Mailing Address - Country:US
Mailing Address - Phone:803-691-1690
Mailing Address - Fax:803-714-6738
Practice Address - Street 1:5900 MAIN ST
Practice Address - Street 2:ECKERD PHARMACY
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6227
Practice Address - Country:US
Practice Address - Phone:803-691-1690
Practice Address - Fax:803-714-6738
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist