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NPI Code Detail

MEDICARE: JACK WEBER

MEDICARE: JACK WEBER
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
1183500000XPharmacistS00974AZ

General Provider Information

NPI Number : 1225437049
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK WEBER
Provider Business Mailing Address
First Line : 4505 E MCKELLIPS RD
Second Line :
City : MESA
State : AZ
Zip : 85215-2523
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4505 E MCKELLIPS RD
Second Line :
City : MESA
State : AZ
Zip : 85215-2523
Country : US
Telephone Number : 480-641-6740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2014
Last Update Date : 08/18/2014

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Directions to “ JACK WEBER ” Practice Location

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