Provider Demographics
NPI:1548912124
Name:JAYNES, MASON I (PHARMD)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:I
Last Name:JAYNES
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 1:2910 VOELKEL AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2079
Mailing Address - Country:US
Mailing Address - Phone:724-880-1675
Mailing Address - Fax:
Practice Address - Street 1:390 BIRCH ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-9042
Practice Address - Country:US
Practice Address - Phone:304-285-7348
Practice Address - Fax:304-285-7349
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0011490183500000X
MD27929183500000X
PARP452885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist