Healthcare Provider Details

I. General information

NPI: 1831714989
Provider Name (Legal Business Name): JEREMY MICHAEL GERBER PHARMD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 11/27/2023
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14200 W CELEBRATE LIFE WAY
GOODYEAR AZ
85338-3007
US

IV. Provider business mailing address

13621 W VERDE LN
AVONDALE AZ
85392-3564
US

V. Phone/Fax

Practice location:
  • Phone: 623-207-3247
  • Fax:
Mailing address:
  • Phone: 570-239-3987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15008
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number15008
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number15008
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: