Provider Demographics
NPI:1235791971
Name:JARECKI, ROBERT (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:JARECKI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4791
Mailing Address - Country:US
Mailing Address - Phone:920-285-0773
Mailing Address - Fax:
Practice Address - Street 1:625 W TELEGRAPH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-1541
Practice Address - Country:US
Practice Address - Phone:435-628-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11118-40183500000X
AZS023262183500000X
NV19894183500000X
UT7598176-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist