Provider Demographics
NPI:1295965283
Name:PERGERSON, JAMIE M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:M
Last Name:PERGERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-6123
Mailing Address - Country:US
Mailing Address - Phone:336-597-5030
Mailing Address - Fax:336-597-4047
Practice Address - Street 1:1049 DURHAM RD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-6123
Practice Address - Country:US
Practice Address - Phone:336-597-5030
Practice Address - Fax:336-597-4047
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2014-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist