Provider Demographics
NPI:1053046391
Name:JEFFERIS, JAMES EUGENE
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EUGENE
Last Name:JEFFERIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:KS
Mailing Address - Zip Code:66748-1908
Mailing Address - Country:US
Mailing Address - Phone:620-473-2520
Mailing Address - Fax:
Practice Address - Street 1:204 S 9TH ST # YH
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:KS
Practice Address - Zip Code:66748-1908
Practice Address - Country:US
Practice Address - Phone:620-473-2520
Practice Address - Fax:620-473-2414
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist