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NPI Code Detail

MEDICARE: JEFFREY RYAN KOLB PHARMD

MEDICARE: JEFFREY RYAN KOLB PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistS024766AZ

General Provider Information

NPI Number : 1033729702
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY RYAN KOLB PHARMD
Provider Business Mailing Address
First Line : 8236 E HERMOSA VISTA DR
Second Line :
City : MESA
State : AZ
Zip : 85207-1322
Country : US
Telephone Number : 760-331-9578
Fax Number :
Provider Business Practice Location Address
First Line : 3450 N GLASSFORD HILL RD
Second Line :
City : PRESCOTT VALLEY
State : AZ
Zip : 86314-1351
Country : US
Telephone Number : 928-499-3136
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2020
Last Update Date : 11/16/2020

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