Provider Demographics
NPI:1225401607
Name:DAUBE, JEREMY B (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:B
Last Name:DAUBE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 A ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4050
Mailing Address - Country:US
Mailing Address - Phone:907-565-6600
Mailing Address - Fax:907-563-6602
Practice Address - Street 1:3101 A ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4050
Practice Address - Country:US
Practice Address - Phone:907-565-6600
Practice Address - Fax:907-563-6602
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist