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General NPI Number Information
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NPI Number | 1457134603
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Entity Type | Individual
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Provider Name | JAKE RICHARD CORMIER PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 10401 W THUNDERBIRD BLVD
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City | SUN CITY
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State | AZ
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Zip | 85351-3004
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Country | US
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Telephone | 623-832-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 4130 W CALAVAR RD
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City | PHOENIX
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State | AZ
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Zip | 85053-5364
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Country | US
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Telephone | 719-480-0755
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Fax |
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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 | S026579
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License Number State | AZ
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