Healthcare Provider Details

I. General information

NPI: 1376309963
Provider Name (Legal Business Name): JOSE MANUEL MEJIA JR. PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N CENTRAL AVE STE 102
PHOENIX AZ
85004-1829
US

IV. Provider business mailing address

1101 N CENTRAL AVE STE 102
PHOENIX AZ
85004-1829
US

V. Phone/Fax

Practice location:
  • Phone: 855-428-3552
  • Fax:
Mailing address:
  • Phone: 855-428-3552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS026336
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: