MEDICARE: DR. JEREMY W VETETO PHARM.D.

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	AR8860	AR

General Provider Information

NPI Number	:	1841304334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY W VETETO PHARM.D.

Provider Business Mailing Address
First Line	:	11342 SPRING MOUNTAIN DR
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-9552
Country	:	US
Telephone Number	:	479-267-3870
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W DICKSON ST
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-5219
Country	:	US
Telephone Number	:	479-442-6262
Fax Number	:	479-521-9111

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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