Provider Demographics
NPI:1053091702
Name:MAYFIELD, JARED AUSTIN (PHARMD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:AUSTIN
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 DARWIN RD
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-5705
Mailing Address - Country:US
Mailing Address - Phone:864-266-9164
Mailing Address - Fax:
Practice Address - Street 1:1818 W DIXON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-4351
Practice Address - Country:US
Practice Address - Phone:704-482-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist