Healthcare Provider Details

I. General information

NPI: 1053476069
Provider Name (Legal Business Name): JEREMIAH JOHN DUBY PHARM.D., BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

2815 ECCLESTON AVE
WALNUT CREEK CA
94597-1816
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-2072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number57496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: