MEDICARE: MR. JARED A MCCRORIE 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
1	183500000X	Pharmacist	PH27495	MA

General Provider Information

NPI Number	:	1720374259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JARED A MCCRORIE PHARM D

Provider Business Mailing Address
First Line	:	579 GRAND ARMY HWY
Second Line	:	T2607
City	:	SWANSEA
State	:	MA
Zip	:	02777-4587
Country	:	US
Telephone Number	:	774-488-3685
Fax Number	:	774-488-3637

Provider Business Practice Location Address
First Line	:	579 GRAND ARMY HWY
Second Line	:	T2607
City	:	SWANSEA
State	:	MA
Zip	:	02777-4587
Country	:	US
Telephone Number	:	774-488-3685
Fax Number	:	774-488-3637

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

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	06/23/2011

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