Healthcare Provider Details

I. General information

NPI: 1053628842
Provider Name (Legal Business Name): JERRY MICHAEL HORNER PHARM.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 EAST ST
CONCORD CA
94520-1906
US

IV. Provider business mailing address

727 NAVARONNE WAY
CONCORD CA
94518-2322
US

V. Phone/Fax

Practice location:
  • Phone: 925-682-8200
  • Fax:
Mailing address:
  • Phone: 209-484-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: