Provider Demographics
NPI:1730480807
Name:ROSWURM, JARED WAYNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:WAYNE
Last Name:ROSWURM
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 1:4005 E CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8888
Mailing Address - Country:US
Mailing Address - Phone:480-759-4479
Mailing Address - Fax:480-759-8644
Practice Address - Street 1:4005 E CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8888
Practice Address - Country:US
Practice Address - Phone:480-759-4479
Practice Address - Fax:480-759-8644
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist