MEDICARE: GARY STEPHEN JARED SR. RPH

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
1	183500000X	Pharmacist	9872	NC

General Provider Information

NPI Number	:	1073542957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY STEPHEN JARED SR. RPH

Provider Business Mailing Address
First Line	:	3504 SHEFFIELD DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27803
Country	:	US
Telephone Number	:	252-937-5055
Fax Number	:	252-442-0332

Provider Business Practice Location Address
First Line	:	329 N FAIRVIEW RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27801
Country	:	US
Telephone Number	:	252-442-8159
Fax Number	:	252-442-0332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	07/08/2007

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