Provider Demographics
NPI:1386867893
Name:FITZGERALD, JEFF CARVER (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:CARVER
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 LONG AVE
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-5135
Mailing Address - Country:US
Mailing Address - Phone:336-599-7855
Mailing Address - Fax:
Practice Address - Street 1:605 S MORGAN ST
Practice Address - Street 2:POB 1359
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5435
Practice Address - Country:US
Practice Address - Phone:336-599-2166
Practice Address - Fax:336-599-0955
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist