Provider Demographics
NPI:1124399068
Name:EARTHMAN, JASON A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:EARTHMAN
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 1:8008 FOUTS PL
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1018
Mailing Address - Country:US
Mailing Address - Phone:806-683-1274
Mailing Address - Fax:806-350-6340
Practice Address - Street 1:8008 FOUTS PL
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-1018
Practice Address - Country:US
Practice Address - Phone:806-683-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist