Provider Demographics
NPI:1114101185
Name:BLITZ, JASON M (RPH)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:BLITZ
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 1:485 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BIG FLATS
Mailing Address - State:NY
Mailing Address - Zip Code:14814-9701
Mailing Address - Country:US
Mailing Address - Phone:607-358-4200
Mailing Address - Fax:607-358-4204
Practice Address - Street 1:485 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BIG FLATS
Practice Address - State:NY
Practice Address - Zip Code:14814-9701
Practice Address - Country:US
Practice Address - Phone:607-358-4200
Practice Address - Fax:607-358-4204
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist