Provider Demographics
NPI:1003906660
Name:CRADER, JASON (RPH)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:CRADER
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 1:411 OSAGE DR
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63730-8062
Mailing Address - Country:US
Mailing Address - Phone:573-887-3622
Mailing Address - Fax:573-334-4797
Practice Address - Street 1:211 W YOAKUM AVE
Practice Address - Street 2:
Practice Address - City:CHAFFEE
Practice Address - State:MO
Practice Address - Zip Code:63740-1138
Practice Address - Country:US
Practice Address - Phone:573-887-3622
Practice Address - Fax:573-334-4797
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist