Provider Demographics
NPI:1467190116
Name:BYERS, JASMINE CEIRA (CPHT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:CEIRA
Last Name:BYERS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 GRAND CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-1347
Mailing Address - Country:US
Mailing Address - Phone:304-295-4573
Mailing Address - Fax:304-295-0639
Practice Address - Street 1:2300 GRAND CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-1347
Practice Address - Country:US
Practice Address - Phone:304-295-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVTT0016444183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician