MEDICARE: JARVIS ALEXANDER PERRY 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	RPH033553	GA

General Provider Information

NPI Number	:	1669104758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARVIS ALEXANDER PERRY PHARMD

Provider Business Mailing Address
First Line	:	634 ROY HUIE RD APT 12E
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-1743
Country	:	US
Telephone Number	:	770-377-2365
Fax Number	:

Provider Business Practice Location Address
First Line	:	4617 JONESBORO RD
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-2048
Country	:	US
Telephone Number	:	770-969-7458
Fax Number	:

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

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/27/2022

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