Provider Demographics
NPI:1497083810
Name:JEROME, PATRICK DON III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DON
Last Name:JEROME
Suffix:III
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 1:8736 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-4016
Mailing Address - Country:US
Mailing Address - Phone:520-546-1378
Mailing Address - Fax:520-546-1560
Practice Address - Street 1:8736 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-4016
Practice Address - Country:US
Practice Address - Phone:520-546-1378
Practice Address - Fax:520-546-1560
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS014184Other18-PHARMACY SERVICE PROVIDER