Provider Demographics
NPI:1225182777
Name:MONTIERTH, ROBERT JARED (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JARED
Last Name:MONTIERTH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 W CRIMSON CANYON DR
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2149
Mailing Address - Country:US
Mailing Address - Phone:928-348-7519
Mailing Address - Fax:
Practice Address - Street 1:2125 W US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:THATCHER
Practice Address - State:AZ
Practice Address - Zip Code:85552-5446
Practice Address - Country:US
Practice Address - Phone:928-428-7244
Practice Address - Fax:928-428-7270
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist