Individual
JOHN JACOB PETRICH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
R.P.H.
Contact information
Practice address
1319 WOODSIDE AVE, GREENVILLE, SC 29611-3738
(864) 232-4662
(864) 271-5276
Mailing address
1319 WOODSIDE AVE, GREENVILLE, SC 29611-3738
(864) 232-4662
(864) 271-5276
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5505
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
726101
—
SC
05
—
DME458
—
SC
Enumeration date
11/17/2005
Last updated
07/09/2007
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