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Individual

MR. JACK PERSHING PADGETT JR.

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
BS, RPH

Contact information

Practice address
540 NORTH ST, BAMBERG, SC 29003-1319
(803) 245-4298
(803) 245-1232
Mailing address
540 NORTH ST, BAMBERG, SC 29003-1319
(803) 245-4298
(803) 245-1232

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4186
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4202329
NABP
05
716647
SC
01
DE1340
DME MEDICAID
SC
Enumeration date
09/21/2005
Last updated
07/08/2007
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