Provider Demographics
NPI:1194711689
Name:PADGETT, JACK PERSHING JR (BS, RPH)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:PERSHING
Last Name:PADGETT
Suffix:JR
Gender:M
Credentials:BS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-1319
Mailing Address - Country:US
Mailing Address - Phone:803-245-4298
Mailing Address - Fax:803-245-1232
Practice Address - Street 1:540 NORTH ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1319
Practice Address - Country:US
Practice Address - Phone:803-245-4298
Practice Address - Fax:803-245-1232
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC716647Medicaid
SCDE1340OtherDME MEDICAID
4202329OtherNABP
SCDE1340OtherDME MEDICAID