Provider Demographics
NPI:1366424053
Name:JEWELL, JEROD AMOO (RPH)
Entity type:Individual
Prefix:
First Name:JEROD
Middle Name:AMOO
Last Name:JEWELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 N PIEDRAS ST
Mailing Address - Street 2:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-569-1184
Mailing Address - Fax:915-569-1195
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-569-1184
Practice Address - Fax:915-569-1195
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX36535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist