Individual
MR. EDGAR ROGERS JETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1511
(602) 263-1619
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1511
(602) 263-1619
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11825
AZ
Other
Enumeration date
10/17/2006
Last updated
07/08/2007
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