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General NPI Number Information
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NPI Number | 1720767049
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Entity Type | Individual
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Provider Name | JAY M GIVENS D.PH
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Gender | Male
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 3260 E BATTLEFIELD ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4051
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Country | US
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Telephone | 417-887-5516
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Fax | 417-887-4308
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Provider Business Mailing Address
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Address Line | 3260 E BATTLEFIELD ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4051
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Country | US
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Telephone | 417-887-5516
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Fax | 417-887-4308
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2000148994
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License Number State | MO
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