Jerry Mark Fletcher, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

16409 Issued in LA

Practice address

204 W Hill Blvd
628 Medical Group Pharmacy
Joint Base Charleston, SC 29404-4704

Phone

(843) 963-6809

NPI assigned

Oct 11, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364169600000",
    "number": "1689763526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 W HILL BLVD",
            "address_2": "628 MEDICAL GROUP",
            "city": "JOINT BASE CHARLESTON",
            "state": "SC",
            "postal_code": "294044704",
            "telephone_number": "843-963-6809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W HILL BLVD",
            "address_2": "628 MEDICAL GROUP PHARMACY",
            "city": "JOINT BASE CHARLESTON",
            "state": "SC",
            "postal_code": "294044704",
            "telephone_number": "843-963-6809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLETCHER",
        "first_name": "JERRY",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2013-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "16409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virginia Bulleman, LISW-CP
• Alysha Buonerba
• Matthew Burns, D.M.D.
• Jazmin Cribb
• Harrison Dilworth, MD
• David Joseph Fulbrook, DO
• Whitney Mark Galloway, PA-C
• Sara T Hansen, LISW-CP
• Samantha Marie Knapp, PA-C
• Laura Mansfield

• Pharmacist in Joint Base Charleston, SC
• Providers in Joint Base Charleston, SC by specialty
• Pharmacist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.