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NPI Code Detail

MEDICARE: JORGE JERIA PHARM. D

MEDICARE: JORGE JERIA PHARM. D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist55774TX

General Provider Information

NPI Number : 1518360379
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE JERIA PHARM. D
Provider Business Mailing Address
First Line : 1531 GEORGE DIETER DR
Second Line : APT 909
City : EL PASO
State : TX
Zip : 79936-7663
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12201 MONTWOOD DR
Second Line : APT 909
City : EL PASO
State : TX
Zip : 79938-2620
Country : US
Telephone Number : 915-856-0278
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2014
Last Update Date : 10/07/2014

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