Provider Demographics
NPI:1891881413
Name:WARNER, JEFFREY LOUIS (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LOUIS
Last Name:WARNER
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 1:1417 N. MAIN STREET
Mailing Address - Street 2:SUITE A P O BOX 499
Mailing Address - City:JAMESTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42629
Mailing Address - Country:US
Mailing Address - Phone:270-343-4444
Mailing Address - Fax:270-343-4481
Practice Address - Street 1:1417 N. MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:JAMESTOWN
Practice Address - State:KY
Practice Address - Zip Code:42629
Practice Address - Country:US
Practice Address - Phone:270-343-4444
Practice Address - Fax:270-343-4481
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54006713Medicaid
1814575OtherNCPDP
1814575OtherNCPDP