Provider Demographics
NPI:1154140911
Name:SMITH, JACOB SCOTT (PHARMD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:SCOTT
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 HARBOR POINTE DR APT 10
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5611
Mailing Address - Country:US
Mailing Address - Phone:864-421-4069
Mailing Address - Fax:
Practice Address - Street 1:3951 W ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-9156
Practice Address - Country:US
Practice Address - Phone:184-376-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC60353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist