Provider Demographics
NPI:1861775637
Name:JAYNE, KATHERINE JEANETTE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JEANETTE
Last Name:JAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6831
Mailing Address - Country:US
Mailing Address - Phone:989-894-3744
Mailing Address - Fax:989-894-6135
Practice Address - Street 1:1900 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6831
Practice Address - Country:US
Practice Address - Phone:989-894-3744
Practice Address - Fax:989-894-6135
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist