MEDICARE: JARED LONGLAIS 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	18808-40	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18808-40	OTHER	WI	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1811401979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED LONGLAIS PHARMD

Provider Business Mailing Address
First Line	:	1753 N HUMBOLDT AVE LOWR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-1664
Country	:	US
Telephone Number	:	720-737-9327
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1869
Country	:	US
Telephone Number	:	414-463-1111
Fax Number	:	414-463-1112

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

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	03/17/2018

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Directions to “ JARED LONGLAIS PHARMD” Practice Location

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