MEDICARE: DR. JEREMY BURGESS 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	183500000X	Pharmacist	03236573	OH

General Provider Information

NPI Number	:	1306231089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY BURGESS PHARMD

Provider Business Mailing Address
First Line	:	6300 SCIOTO DARBY RD
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-9726
Country	:	US
Telephone Number	:	614-529-2604
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 SCIOTO DARBY RD
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-9726
Country	:	US
Telephone Number	:	614-529-2604
Fax Number	:

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

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	11/18/2020

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