MEDICARE: DR. JEREMY WAYNE BAREFOOT 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	183500000X	Pharmacist	29956	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29956	OTHER	NC	NCBOP LICENSE

General Provider Information

NPI Number	:	1851997068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY WAYNE BAREFOOT PHARMD

Provider Business Mailing Address
First Line	:	101 E J ST
Second Line	:
City	:	ERWIN
State	:	NC
Zip	:	28339-1509
Country	:	US
Telephone Number	:	910-818-5928
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 COLLEGE ST
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-3501
Country	:	US
Telephone Number	:	910-592-4058
Fax Number	:

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

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	12/11/2020

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