Provider Demographics
NPI:1649690587
Name:MESTAYER, JAMES ALLEN II (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:MESTAYER
Suffix:II
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CROSS CREEK PKWY APT 531
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-4426
Mailing Address - Country:US
Mailing Address - Phone:504-458-0073
Mailing Address - Fax:
Practice Address - Street 1:5093 HARDY ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-579-6698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-06784183500000X
LA15787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist