Provider Demographics
NPI:1629631304
Name:OVERMAN, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:OVERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2702
Mailing Address - Country:US
Mailing Address - Phone:970-493-3934
Mailing Address - Fax:970-493-7977
Practice Address - Street 1:1250 E MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2702
Practice Address - Country:US
Practice Address - Phone:970-493-3934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist