Healthcare Provider Details

I. General information

NPI: 1235791971
Provider Name (Legal Business Name): ROBERT JARECKI PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W TELEGRAPH ST
WASHINGTON UT
84780-1541
US

IV. Provider business mailing address

1983 CENTENNIAL DR
ST GEORGE UT
84770-4791
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-2824
  • Fax:
Mailing address:
  • Phone: 920-285-0773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11118-40
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS023262
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19894
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7598176-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: