MEDICARE: JAYNA WITTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH-0015427	OR
2	183500000X	Pharmacist	P7526	ID

General Provider Information

NPI Number	:	1528512464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYNA WITTY

Provider Business Mailing Address
First Line	:	728 SW 4TH AVE
Second Line	:
City	:	ONTARIO
State	:	OR
Zip	:	97914-2626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	728 SW 4TH AVE
Second Line	:
City	:	ONTARIO
State	:	OR
Zip	:	97914-2626
Country	:	US
Telephone Number	:	541-889-3390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	08/09/2016

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Directions to “ JAYNA WITTY ” Practice Location

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