MEDICARE: JOHN JERROLDS PHARMD

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
1	183500000X	Pharmacist	2021014019	MO
2	183500000X	Pharmacist	21341	AL
3	183500000X	Pharmacist	39403	TN

General Provider Information

NPI Number	:	1578168522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JERROLDS PHARMD

Provider Business Mailing Address
First Line	:	3171 RIVERPORT TECH CENTER DR
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-4825
Country	:	US
Telephone Number	:	731-607-2743
Fax Number	:

Provider Business Practice Location Address
First Line	:	3171 RIVERPORT TECH CENTER DR
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-4825
Country	:	US
Telephone Number	:	731-607-2743
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	09/25/2024

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Directions to “ JOHN JERROLDS PHARMD” Practice Location

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