Provider Demographics
NPI:1164426615
Name:BACKEL, JASON (RPH)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BACKEL
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 1:241 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-1128
Mailing Address - Country:US
Mailing Address - Phone:740-942-2726
Mailing Address - Fax:
Practice Address - Street 1:241 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-1128
Practice Address - Country:US
Practice Address - Phone:740-942-2726
Practice Address - Fax:740-942-2182
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-22148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2226095Medicaid
WV6001237000Medicaid
WV6001237000Medicaid