Provider Demographics
NPI:1336477850
Name:BOYD, JAY
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:BOYD
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 1:201 FM 1821
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-9125
Mailing Address - Country:US
Mailing Address - Phone:940-325-6084
Mailing Address - Fax:940-325-4913
Practice Address - Street 1:201 FM 1821
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-9125
Practice Address - Country:US
Practice Address - Phone:940-325-6084
Practice Address - Fax:940-325-4913
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist