Healthcare Provider Details

I. General information

NPI: 1710590021
Provider Name (Legal Business Name): JASMINE MAYNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 BURNET AVE
CINCINNATI OH
45229-3019
US

IV. Provider business mailing address

1517 SPRING VALLEY DR
HUNTINGTON WV
25704-9584
US

V. Phone/Fax

Practice location:
  • Phone: 304-785-1528
  • Fax:
Mailing address:
  • Phone: 304-785-1528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number03445209
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: