Provider Demographics
NPI:1124789920
Name:CHAMBERS, JERRY DEAN
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:DEAN
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6549 N PALM AVE APT 150
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1069
Mailing Address - Country:US
Mailing Address - Phone:925-413-8655
Mailing Address - Fax:
Practice Address - Street 1:6074 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5405
Practice Address - Country:US
Practice Address - Phone:559-431-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician