Provider Demographics
NPI:1700125929
Name:DUNCAN, JACOB L (PHARMD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:L
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 GEER HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-1521
Mailing Address - Country:US
Mailing Address - Phone:864-834-4409
Mailing Address - Fax:864-834-2864
Practice Address - Street 1:1500 GEER HIGHWAY
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1521
Practice Address - Country:US
Practice Address - Phone:864-834-4409
Practice Address - Fax:864-834-2864
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist