Healthcare Provider Details

I. General information

NPI: 1356868491
Provider Name (Legal Business Name): JADE LARA ABUDIA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MEDICINE WAY RD
PERIDOT AZ
85542-5000
US

IV. Provider business mailing address

526 E CARICO ST
GLOBE AZ
85501-2382
US

V. Phone/Fax

Practice location:
  • Phone: 928-475-1300
  • Fax:
Mailing address:
  • Phone: 843-909-1665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH030871
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: