Healthcare Provider Details

I. General information

NPI: 1508799743
Provider Name (Legal Business Name): JARROD RAYMOND HISE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 E BASELINE RD STE 104
GILBERT AZ
85233-1224
US

IV. Provider business mailing address

1275 E BASELINE RD STE 104
GILBERT AZ
85233-1224
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-4366
  • Fax: 480-626-4365
Mailing address:
  • Phone: 480-210-9640
  • Fax: 480-626-4365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS027364
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: