Healthcare Provider Details

I. General information

NPI: 1003289133
Provider Name (Legal Business Name): JAMIE PETER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E MERCED ST
FOWLER CA
93625-2312
US

IV. Provider business mailing address

111 E MERCED ST
FOWLER CA
93625-2312
US

V. Phone/Fax

Practice location:
  • Phone: 559-834-1606
  • Fax: 559-834-5841
Mailing address:
  • Phone: 559-834-1606
  • Fax: 559-834-5841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: