Provider Demographics
NPI:1164639548
Name:POQUETTE, JASON JAMES (RPH)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:JAMES
Last Name:POQUETTE
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 1:35 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-1042
Mailing Address - Country:US
Mailing Address - Phone:508-234-4366
Mailing Address - Fax:
Practice Address - Street 1:35 SUNSET DR
Practice Address - Street 2:
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-1042
Practice Address - Country:US
Practice Address - Phone:508-234-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22735183500000X
NHR1839183500000X
MEPR5177183500000X
CT8013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist