Provider Demographics
NPI:1902116338
Name:GEVENOSKY, JASON ROMAN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ROMAN
Last Name:GEVENOSKY
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 1:150 TWIN OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHADY SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:25918
Mailing Address - Country:US
Mailing Address - Phone:304-763-3593
Mailing Address - Fax:
Practice Address - Street 1:2987 ROBERT C BYRD DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4400
Practice Address - Country:US
Practice Address - Phone:304-252-6331
Practice Address - Fax:304-252-0075
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist