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General NPI Number Information
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NPI Number | 1902116338
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Entity Type | Individual
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Provider Name | JASON ROMAN GEVENOSKY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 2987 ROBERT C BYRD DR
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City | BECKLEY
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State | WV
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Zip | 25801-4400
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Country | US
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Telephone | 304-252-6331
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Fax | 304-252-0075
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Provider Business Mailing Address
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Address Line | 150 TWIN OAKS DRIVE
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City | SHADY SPRING
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State | WV
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Zip | 25918
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Country | US
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Telephone | 304-763-3593
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Fax |
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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 | RP0006766
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License Number State | WV
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