Provider Demographics
NPI:1104174754
Name:DANCER, JONATHAN (RPH)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:DANCER
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 1:650 JOHNNIE DODDS BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3013
Mailing Address - Country:US
Mailing Address - Phone:843-849-3471
Mailing Address - Fax:843-216-0751
Practice Address - Street 1:650 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3013
Practice Address - Country:US
Practice Address - Phone:843-849-3471
Practice Address - Fax:843-216-0751
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist