Provider Demographics
NPI:1962827980
Name:JAYNES, MICAH (PHARMD, RP)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:JAYNES
Suffix:
Gender:M
Credentials:PHARMD, RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7334 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4870
Mailing Address - Country:US
Mailing Address - Phone:402-488-2629
Mailing Address - Fax:
Practice Address - Street 1:7334 S 32ND ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4870
Practice Address - Country:US
Practice Address - Phone:402-488-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist