Healthcare Provider Details

I. General information

NPI: 1568380905
Provider Name (Legal Business Name): JASON BARNES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 S GREENFIELD RD
MESA AZ
85206-3303
US

IV. Provider business mailing address

1305 S GREENFIELD RD
MESA AZ
85206-3303
US

V. Phone/Fax

Practice location:
  • Phone: 480-830-9266
  • Fax: 480-830-0075
Mailing address:
  • Phone: 480-830-9266
  • Fax: 480-830-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS015748
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: