Healthcare Provider Details

I. General information

NPI: 1073745766
Provider Name (Legal Business Name): JEFFREY N BARNES PHARMD, MPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 02/22/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52D MEDICAL GROUP UNIT 3690
APO AE
09126
US

IV. Provider business mailing address

PSC 9 BOX 5224
APO AE
09123-0053
US

V. Phone/Fax

Practice location:
  • Phone: 4-965-6561
  • Fax:
Mailing address:
  • Phone: 65-656-1815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number15013
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: