Petrich, John Jacob

Petrich, John Jacob is an individual health care provider with primary practice located at 1319 Woodside Ave , Greenville SC 29611-3738. He recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as his primary health care specialty. Petrich, John Jacob can be contacted via phone (864) 232-4662.

Contact Information

Primary practice address
1319 Woodside Ave Greenville SC 29611-3738
Phone: (864) 232-4662
Fax: (864) 271-5276
Website:
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Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X 5505 South Carolina

Profile Details

NPI number 1700868494
LBN Legal business name Petrich, John Jacob
Credentials R.P.H.
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2005
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700868494 NPPES
South Carolina MEDICAID 726101
South Carolina MEDICAID DME458

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