Provider Demographics
NPI:1689823197
Name:OVERBAY, JEAN M (RPH)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:M
Last Name:OVERBAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SOUTHERN BLVD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2085
Mailing Address - Country:US
Mailing Address - Phone:505-891-0895
Mailing Address - Fax:505-892-3238
Practice Address - Street 1:3301 SOUTHERN BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2085
Practice Address - Country:US
Practice Address - Phone:505-891-0895
Practice Address - Fax:505-892-3238
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist