Provider Demographics
NPI:1174740690
Name:JURASKO, THOMAS (PD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:JURASKO
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MUIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-5334
Mailing Address - Country:US
Mailing Address - Phone:843-215-6686
Mailing Address - Fax:
Practice Address - Street 1:1610 HIGHWAY 17 BUSINESS S
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575
Practice Address - Country:US
Practice Address - Phone:843-650-4536
Practice Address - Fax:843-650-4536
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist