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General NPI Number Information
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NPI Number | 1649663329
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Entity Type | Individual
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Provider Name | JAYDEN LEE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 919 W RIO ALTAR
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-4036
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Country | US
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Telephone | 818-398-8121
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Fax |
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Provider Business Mailing Address
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Address Line | 919 W RIO ALTAR
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-4036
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Country | US
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Telephone | 818-398-8121
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | RPH029713
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | S025192
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PCT.0012000
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License Number State | CT
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