Provider Demographics
NPI:1124355714
Name:MAYFIELD, BRUCE JAY (RPH)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:JAY
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S.W. COURT PLACE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:541-276-1185
Mailing Address - Fax:541-278-1536
Practice Address - Street 1:1900 SW COURT PL
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-1817
Practice Address - Country:US
Practice Address - Phone:541-276-1185
Practice Address - Fax:541-278-1536
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist