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General NPI Number Information
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NPI Number | 1871824755
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Entity Type | Individual
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Provider Name | JANE JOAN DEVRIES PHARMD, RD, CDE
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Gender | Female
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Dates
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Enumeration Date | 01/16/2010
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 350 E SIX FORKS RD
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City | RALEIGH
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State | NC
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Zip | 27609-7879
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Country | US
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Telephone | 919-832-1803
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Fax | 919-828-5265
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Provider Business Mailing Address
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Address Line | 1141 BLYKEFORD LN
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City | WAKE FOREST
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State | NC
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Zip | 27587-8038
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Country | US
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Telephone | 901-299-4220
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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 | 010364
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202211262
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License Number State | VA
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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 | 22323
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | L003965
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License Number State | NC
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