Provider Demographics
NPI:1669641601
Name:NESS, JAYSON DALE
Entity Type:Individual
Prefix:MR
First Name:JAYSON
Middle Name:DALE
Last Name:NESS
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 1:916 OETTER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-3177
Mailing Address - Country:US
Mailing Address - Phone:386-767-0808
Mailing Address - Fax:
Practice Address - Street 1:916 OETTER DR
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3177
Practice Address - Country:US
Practice Address - Phone:386-767-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist