Provider Demographics
NPI:1730638859
Name:BRISCOE, JARED (PHARMD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:BRISCOE
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 1:42 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:OH
Mailing Address - Zip Code:45380-1214
Mailing Address - Country:US
Mailing Address - Phone:937-526-3337
Mailing Address - Fax:937-526-4118
Practice Address - Street 1:42 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:OH
Practice Address - Zip Code:45380-1214
Practice Address - Country:US
Practice Address - Phone:937-526-3337
Practice Address - Fax:937-526-4118
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03225312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist