Provider Demographics
NPI:1336968353
Name:BELARAS, JAY-R RUIZ
Entity type:Individual
Prefix:
First Name:JAY-R
Middle Name:RUIZ
Last Name:BELARAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NW EARL LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1580
Mailing Address - Country:US
Mailing Address - Phone:907-917-6159
Mailing Address - Fax:
Practice Address - Street 1:23 NW EARL LN
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-1580
Practice Address - Country:US
Practice Address - Phone:907-917-6159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61575553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist