Provider Demographics
NPI:1720743578
Name:ALARCON, JESSE JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:JAMES
Last Name:ALARCON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W 24TH PL APT B19
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2143
Mailing Address - Country:US
Mailing Address - Phone:316-518-6792
Mailing Address - Fax:
Practice Address - Street 1:4701 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4825
Practice Address - Country:US
Practice Address - Phone:785-838-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-103656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist