Provider Demographics
NPI:1629535471
Name:MCPHERSON, JERRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:MCPHERSON
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 1:1539 VERSAILLES AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3044
Mailing Address - Country:US
Mailing Address - Phone:510-701-7936
Mailing Address - Fax:
Practice Address - Street 1:1539 VERSAILLES AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-3044
Practice Address - Country:US
Practice Address - Phone:510-701-7936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist