=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750055638
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYCEE EASTON RPH, PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2021
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6635 BASS RD BLDG 9214
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31905-5602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-249-6548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 281 CUMBERLAND BND APT 131
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37228-1816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-249-6548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 24154
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------