Provider Demographics
NPI:1417695388
Name:DING, JEREMY R (PHARMD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:R
Last Name:DING
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 E DEER VALLEY DR UNIT 234
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5665
Mailing Address - Country:US
Mailing Address - Phone:240-421-7276
Mailing Address - Fax:
Practice Address - Street 1:3361 N LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2125
Practice Address - Country:US
Practice Address - Phone:623-935-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025779333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy