Healthcare Provider Details

I. General information

NPI: 1427979301
Provider Name (Legal Business Name): JERRY VAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11116 MEDICAL CAMPUS RD
HAGERSTOWN MD
21742-6710
US

IV. Provider business mailing address

7152 PROCLAMATION PL
FREDERICK MD
21703-2980
US

V. Phone/Fax

Practice location:
  • Phone: 301-790-8925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24364
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: