Individual
JESSICA GAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1014 MONTAGUE AVE, GREENWOOD, SC 29649-1450
(864) 223-6904
Mailing address
29648 HWY 76 E, CLINTON, SC 29325-9995
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
36246
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
750368
NABP
SC
Enumeration date
07/29/2015
Last updated
07/29/2015
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