Provider Demographics
NPI:1770109241
Name:DEAN, JAMI NELL (CPHT)
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:NELL
Last Name:DEAN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4768 STATE ROUTE 775
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-8900
Mailing Address - Country:US
Mailing Address - Phone:740-237-0087
Mailing Address - Fax:
Practice Address - Street 1:4768 STATE ROUTE 775
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-8900
Practice Address - Country:US
Practice Address - Phone:740-237-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT0005652183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician