Individual provider Active NPI

Jared Scott Waxman, PHARMD, RPH

  • Pharmacist
  • Havertown, PA
National Provider Identifier
1407447204
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RP453684 Issued in PA
Practice address
2 E Eagle Rd
Havertown, PA 19083-1495
Phone
(610) 446-4040
Fax
(610) 446-7902
NPI assigned
Feb 3, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RP453684 PA Primary

Addresses

Primary practice location

2 E Eagle Rd
Havertown, PA 19083-1495

Mailing address

325 Penn Rd Unit 145
Wynnewood, PA 19096-1448

Other practice location 1

2070 Sproul Rd
Broomall, PA 19008-2725
Phone (610) 356-6491

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy, Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
RP453684PAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
C & M Pharmacy Inc PastSince Nov 1, 2022 Accepting new patients
Roosevelt Pharmacy LLC PastSince Dec 1, 2024 Accepting new patients
BH Pharmacy LLC PastSince Dec 1, 2024 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760400000000",
    "number": "1407447204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 PENN RD UNIT 145",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190961448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 E EAGLE RD",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190831495",
            "telephone_number": "610-446-4040",
            "fax_number": "610-446-7902"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2070 Sproul Rd",
            "address_purpose": "LOCATION",
            "city": "Broomall",
            "state": "PA",
            "postal_code": "190082725",
            "country_code": "US",
            "telephone_number": "610-356-6491",
            "fax_number": "610-356-6492",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAXMAN",
        "first_name": "JARED",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "PHARMD, RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-03",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "RP453684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Havertown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.