Provider Demographics
NPI:1255377636
Name:FACTOR, JEROME STUART
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:STUART
Last Name:FACTOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7858 E VISAO DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-2770
Mailing Address - Country:US
Mailing Address - Phone:480-991-0357
Mailing Address - Fax:480-595-6344
Practice Address - Street 1:1700 N DESERT DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-1228
Practice Address - Country:US
Practice Address - Phone:602-225-0005
Practice Address - Fax:180-089-9160
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist