Provider Demographics
NPI:1356444244
Name:EAVES, JASON SCOTT (PHARMD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:SCOTT
Last Name:EAVES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12690 ADAM ST
Mailing Address - Street 2:
Mailing Address - City:VENTRESS
Mailing Address - State:LA
Mailing Address - Zip Code:70783-3509
Mailing Address - Country:US
Mailing Address - Phone:225-638-9817
Mailing Address - Fax:
Practice Address - Street 1:213 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760
Practice Address - Country:US
Practice Address - Phone:225-638-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist