Provider Demographics
NPI:1962282970
Name:DISMUKE, JAHNAJA
Entity type:Individual
Prefix:
First Name:JAHNAJA
Middle Name:
Last Name:DISMUKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 MCCAULEY ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-3232
Mailing Address - Country:US
Mailing Address - Phone:870-820-4216
Mailing Address - Fax:
Practice Address - Street 1:640 W GAINES ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4675
Practice Address - Country:US
Practice Address - Phone:870-367-6146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician