Provider Demographics
NPI:1881708725
Name:HITCHCOCK, ROBERT JOLLIE (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOLLIE
Last Name:HITCHCOCK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5828
Mailing Address - Country:US
Mailing Address - Phone:843-444-0476
Mailing Address - Fax:
Practice Address - Street 1:930 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4609
Practice Address - Country:US
Practice Address - Phone:843-449-4751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist