Healthcare Provider Details

I. General information

NPI: 1598167991
Provider Name (Legal Business Name): JAMES FEEZOR PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N
NELLIS AFB NV
89191-6600
US

IV. Provider business mailing address

829 NH ROUTE 11
FARMINGTON NH
03835-3661
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-2114
  • Fax:
Mailing address:
  • Phone: 603-755-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR70617
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS020900
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHCY-00973
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: