Provider Demographics
NPI:1922072578
Name:FOX, JEREMY R (PHARMD BCPS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:R
Last Name:FOX
Suffix:
Gender:M
Credentials:PHARMD BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 FORT HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1022
Mailing Address - Country:US
Mailing Address - Phone:304-388-7882
Mailing Address - Fax:304-388-7820
Practice Address - Street 1:501 MORRIS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1326
Practice Address - Country:US
Practice Address - Phone:304-388-7882
Practice Address - Fax:304-388-7820
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP00068141835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy