Healthcare Provider Details

I. General information

NPI: 1730263021
Provider Name (Legal Business Name): JOANNE JEROME PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY
SANTA ROSA CA
95403-2149
US

IV. Provider business mailing address

321 PORTOFINO WAY
CLOVERDALE CA
95425-3253
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: