Provider Demographics
NPI:1841473113
Name:JAYNES, EVELYN E
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:E
Last Name:JAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:E
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8409 61ST PL NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-8525
Mailing Address - Country:US
Mailing Address - Phone:425-232-6320
Mailing Address - Fax:
Practice Address - Street 1:7001 220TH ST SW
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2160
Practice Address - Country:US
Practice Address - Phone:425-918-6028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00071577183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician