Individual
CHARLES RUSSELL JACO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
510 BOTLEY CT APT 306, FORT MILL, SC 29708
(803) 459-6157
Mailing address
510 BOTLEY CT APT 306, FORT MILL, SC 29708-8239
(803) 459-6157
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12969
SC
Other
Enumeration date
02/04/2011
Last updated
02/04/2011
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