Provider Demographics
NPI:1568046605
Name:JIRLES, JAY TIMOTHY (CPHT)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:TIMOTHY
Last Name:JIRLES
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E WONDER VIEW AVE # B1
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-8927
Mailing Address - Country:US
Mailing Address - Phone:970-586-5577
Mailing Address - Fax:
Practice Address - Street 1:455 E WONDER VIEW AVE # B1
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-8927
Practice Address - Country:US
Practice Address - Phone:970-586-5577
Practice Address - Fax:970-586-0455
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6124183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician