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General NPI Number Information
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NPI Number | 1487706057
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Entity Type | Organization
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Legal Business Name | JEROME DRUGS INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | W230S8715 CLARK ST
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City | BIG BEND
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State | WI
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Zip | 53103
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Country | US
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Telephone | 262-662-5622
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 177
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City | BIG BEND
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State | WI
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Zip | 53103-0177
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Country | US
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Telephone | 262-662-5622
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. JEFFFERY J GOTTFRIED
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Credential | R.PH
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Telephone | 262-662-5622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 7152
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License Number State | WI
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