Provider Demographics
NPI:1396269551
Name:RUTHERFORD, JAYSON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAYSON
Middle Name:
Last Name:RUTHERFORD
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 1:1515 OLD GARNER RD
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76088-8722
Mailing Address - Country:US
Mailing Address - Phone:817-773-0263
Mailing Address - Fax:
Practice Address - Street 1:225 E SPRING ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-3380
Practice Address - Country:US
Practice Address - Phone:817-594-9816
Practice Address - Fax:817-594-9371
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist