Provider Demographics
NPI:1053131961
Name:DYGERT, JACOB (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:DYGERT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:DYGERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3340 SHIPLEY ST APT 5220
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4185
Mailing Address - Country:US
Mailing Address - Phone:843-817-1760
Mailing Address - Fax:
Practice Address - Street 1:354 FOLLY RD STE 1
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2594
Practice Address - Country:US
Practice Address - Phone:843-762-8155
Practice Address - Fax:843-762-8156
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPH.60408PH183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist