MEDICARE: JAY TIMOTHY JIRLES CPHT

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	183700000X	Pharmacy Technician	6124	CO

General Provider Information

NPI Number	:	1568046605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY TIMOTHY JIRLES CPHT

Provider Business Mailing Address
First Line	:	455 E WONDER VIEW AVE # B1
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-8927
Country	:	US
Telephone Number	:	970-586-5577
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 E WONDER VIEW AVE # B1
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-8927
Country	:	US
Telephone Number	:	970-586-5577
Fax Number	:	970-586-0455

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	05/05/2021

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