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General NPI Number Information
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NPI Number | 1255741112
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Entity Type | Individual
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Provider Name | JAMES ALBERT VERNON REG PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 25817 S SHERBROOK DR
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City | SUN LAKES
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State | AZ
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Zip | 85248-6838
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Country | US
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Telephone | 480-895-6625
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Fax | 480-895-3885
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Provider Business Mailing Address
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Address Line | 25817 S SHERBROOK DR
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City | SUN LAKES
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State | AZ
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Zip | 85248-6838
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Country | US
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Telephone | 480-895-6625
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Fax | 480-895-3885
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | SO3432
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License Number State | AZ
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