Provider Demographics
NPI:1922389360
Name:HUMPHRIES, JASON NEIL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:NEIL
Last Name:HUMPHRIES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2135
Mailing Address - Country:US
Mailing Address - Phone:859-266-1171
Mailing Address - Fax:859-266-7603
Practice Address - Street 1:1300 US HIGHWAY 127 S STE E
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4395
Practice Address - Country:US
Practice Address - Phone:502-223-3728
Practice Address - Fax:502-223-3790
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54012745Medicaid