MEDICARE: JERAD WILLIAM COX

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	PHA-PHA-LIC-65963	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P8471	OTHER	ID	PHARMACIST

General Provider Information

NPI Number	:	1174129753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERAD WILLIAM COX

Provider Business Mailing Address
First Line	:	1400 N 19TH AVE
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-3647
Country	:	US
Telephone Number	:	406-586-3550
Fax Number	:	406-586-0788

Provider Business Practice Location Address
First Line	:	1400 N 19TH AVE
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-3647
Country	:	US
Telephone Number	:	406-586-3550
Fax Number	:	406-586-0788

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

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	12/08/2020

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Directions to “ JERAD WILLIAM COX ” Practice Location

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