Provider Demographics
NPI:1386059376
Name:REDFIELD, JERRY JR
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:REDFIELD
Suffix:JR
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 1:644 E HEARNE WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-6444
Mailing Address - Country:US
Mailing Address - Phone:480-216-2240
Mailing Address - Fax:
Practice Address - Street 1:1686 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4777
Practice Address - Country:US
Practice Address - Phone:520-876-4357
Practice Address - Fax:520-876-5031
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist