Provider Demographics
NPI:1720374259
Name:MCCRORIE, JARED A (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:A
Last Name:MCCRORIE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 GRAND ARMY HWY
Mailing Address - Street 2:T2607
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-4587
Mailing Address - Country:US
Mailing Address - Phone:774-488-3685
Mailing Address - Fax:774-488-3637
Practice Address - Street 1:579 GRAND ARMY HWY
Practice Address - Street 2:T2607
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4587
Practice Address - Country:US
Practice Address - Phone:774-488-3685
Practice Address - Fax:774-488-3637
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH27495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist