Provider Demographics
NPI:1013519982
Name:MCBRIDE, JAIRUS MATTHEW (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAIRUS
Middle Name:MATTHEW
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:JAIRUS
Other - Middle Name:MATTHEW
Other - Last Name:HOVEY-MCBRIDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1582 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-2824
Mailing Address - Country:US
Mailing Address - Phone:605-651-6117
Mailing Address - Fax:507-625-4735
Practice Address - Street 1:410 S RIVERFRONT DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3773
Practice Address - Country:US
Practice Address - Phone:507-345-5091
Practice Address - Fax:507-625-4735
Is Sole Proprietor?:No
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist