Provider Demographics
NPI:1730209651
Name:JERRY, DEBORAH M (RPH)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:M
Last Name:JERRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15101 COLLEGIATE CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0344
Mailing Address - Country:US
Mailing Address - Phone:225-767-0532
Mailing Address - Fax:225-578-7684
Practice Address - Street 1:LSU-STUDENT HEALTH CTR
Practice Address - Street 2:INFIRMARY RD RM 172
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70803-0001
Practice Address - Country:US
Practice Address - Phone:225-578-5651
Practice Address - Fax:225-578-7684
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist