Healthcare Provider Details

I. General information

NPI: 1891249983
Provider Name (Legal Business Name): JERARD JAMENA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 W SUNSHINE ST
SPRINGFIELD MO
65807-0906
US

IV. Provider business mailing address

3520 W SUNSHINE ST
SPRINGFIELD MO
65807-0906
US

V. Phone/Fax

Practice location:
  • Phone: 417-864-8006
  • Fax:
Mailing address:
  • Phone: 417-864-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2016020569
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: