Provider Demographics
NPI:1982764353
Name:FAVRE, JONATHAN KEENE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:KEENE
Last Name:FAVRE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5760 N BARRASCA AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1330
Mailing Address - Country:US
Mailing Address - Phone:520-529-2714
Mailing Address - Fax:520-577-6701
Practice Address - Street 1:5760 N BARRASCA AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-1330
Practice Address - Country:US
Practice Address - Phone:520-529-2714
Practice Address - Fax:520-577-6701
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ122531835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy