Provider Demographics
NPI:1386989879
Name:BARKER, JEFFREY LEE
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEE
Last Name:BARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 FAIRVIEW RD STE C
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6777
Mailing Address - Country:US
Mailing Address - Phone:864-962-0251
Mailing Address - Fax:864-963-7579
Practice Address - Street 1:655 FAIRVIEW RD STE C
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6777
Practice Address - Country:US
Practice Address - Phone:864-962-0251
Practice Address - Fax:864-963-7579
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist