Provider Demographics
NPI:1255741112
Name:VERNON, JAMES ALBERT (REG PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALBERT
Last Name:VERNON
Suffix:
Gender:M
Credentials:REG PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25817 S SHERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SUN LAKES
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-6838
Mailing Address - Country:US
Mailing Address - Phone:480-895-6625
Mailing Address - Fax:480-895-3885
Practice Address - Street 1:25817 S SHERBROOK DR
Practice Address - Street 2:
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-6838
Practice Address - Country:US
Practice Address - Phone:480-895-6625
Practice Address - Fax:480-895-3885
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSO3432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist