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General NPI Number Information
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NPI Number | 1063986511
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Entity Type | Organization
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Legal Business Name | ZJRD, LLC
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 13090 N 94TH DR STE 212
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City | PEORIA
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State | AZ
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Zip | 85381-4258
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Country | US
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Telephone | 773-547-8200
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Fax | 602-714-7176
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Provider Business Mailing Address
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Address Line | 13090 N 94TH DR STE 212
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City | PEORIA
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State | AZ
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Zip | 85381-4258
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Country | US
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Telephone | 773-547-8200
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Fax | 602-714-7176
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Authorized Official
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Title or Position | OWNER
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Name | ADAM T KRAMER
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Credential | MD
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Telephone | 773-547-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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