Provider Demographics
NPI:1497355903
Name:STILES, JANA
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:STILES
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 1:517 BROCK RD
Mailing Address - Street 2:
Mailing Address - City:PAINT LICK
Mailing Address - State:KY
Mailing Address - Zip Code:40461-9527
Mailing Address - Country:US
Mailing Address - Phone:859-339-0718
Mailing Address - Fax:
Practice Address - Street 1:120 JILL DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1677
Practice Address - Country:US
Practice Address - Phone:859-986-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist