Jereme Ajaz Azeez, PHARMD, RPH
Individual provider Active NPI Pharmacist · Fair Grove, MO
NPI 1972888055 · NPPES record last updated Apr 24, 2013
Key facts
- NPI
- 1972888055
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2004035743 (MO)
- Practice address
- 49 E Old Mill Rd
Fair Grove, MO 65648-8452 - Phone
- (417) 759-6300
- NPI assigned
- Oct 20, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004035743 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2004035743 | MO | Yes |
Addresses
Primary practice location
49 E Old Mill Rd
Fair Grove, MO 65648-8452
Mailing address
8195 N Farm Road 197
Fair Grove, MO 65648-8268
Other providers in Fair Grove, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.