Provider Demographics
NPI:1659897890
Name:STAUBER, JESSE RICHARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:RICHARD
Last Name:STAUBER
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 1:1374 E ALOE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2506
Mailing Address - Country:US
Mailing Address - Phone:480-560-9871
Mailing Address - Fax:
Practice Address - Street 1:5975 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3422
Practice Address - Country:US
Practice Address - Phone:480-753-1827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist