Provider Demographics
NPI:1578275343
Name:MCCOMAS, JEREMY LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:LEE
Last Name:MCCOMAS
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 1:631 MARY ELLEN DR
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-1701
Mailing Address - Country:US
Mailing Address - Phone:606-831-6273
Mailing Address - Fax:
Practice Address - Street 1:1900 ARGILLITE RD
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1616
Practice Address - Country:US
Practice Address - Phone:606-836-2498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist