Provider Demographics
NPI:1124388376
Name:PARTON, JAY S (RPH)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:S
Last Name:PARTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E COKE RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-3213
Mailing Address - Country:US
Mailing Address - Phone:903-342-3669
Mailing Address - Fax:903-342-6120
Practice Address - Street 1:211 E COKE RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3213
Practice Address - Country:US
Practice Address - Phone:903-342-3669
Practice Address - Fax:903-342-6120
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PH0346OtherMEDICARE FLU SHOTS
TX144190Medicaid
TX144190Medicaid