Provider Demographics
NPI:1841623394
Name:WARREN, JAMIE LEAH (PHARMD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEAH
Last Name:WARREN
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 1:2100 MADISON AVE
Mailing Address - Street 2:INPATIENT PHARMACY
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4701
Mailing Address - Country:US
Mailing Address - Phone:618-798-3239
Mailing Address - Fax:618-798-3882
Practice Address - Street 1:2100 MADISON AVE
Practice Address - Street 2:INPATIENT PHARMACY
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4701
Practice Address - Country:US
Practice Address - Phone:618-798-3239
Practice Address - Fax:618-798-3882
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist