Provider Demographics
NPI:1548541659
Name:MAYES, JASON (PHARMD, BCACP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MAYES
Suffix:
Gender:M
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 DECLARATION DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-7931
Mailing Address - Country:US
Mailing Address - Phone:859-898-1620
Mailing Address - Fax:859-898-1621
Practice Address - Street 1:1700 DECLARATION DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-7931
Practice Address - Country:US
Practice Address - Phone:859-898-1620
Practice Address - Fax:859-898-1621
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013622183500000X
OH03228063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist