Provider Demographics
NPI:1205149499
Name:MAYES, JOSEPH BRYAN
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BRYAN
Last Name:MAYES
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 1:2041 DEWEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-3347
Mailing Address - Country:US
Mailing Address - Phone:814-725-8850
Mailing Address - Fax:
Practice Address - Street 1:2041 DEWEY RD
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-3347
Practice Address - Country:US
Practice Address - Phone:814-725-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist