Healthcare Provider Details

I. General information

NPI: 1972338630
Provider Name (Legal Business Name): JERRY ZENG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 W APACHE TRL
APACHE JUNCTION AZ
85120-3608
US

IV. Provider business mailing address

657 E HOPKINS RD
GILBERT AZ
85295-1588
US

V. Phone/Fax

Practice location:
  • Phone: 380-288-2728
  • Fax:
Mailing address:
  • Phone: 623-707-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS027169
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: