Provider Demographics
NPI:1225488604
Name:SMILOWSKI, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SMILOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10394 GREYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7650
Mailing Address - Country:US
Mailing Address - Phone:248-982-2136
Mailing Address - Fax:
Practice Address - Street 1:10394 GREYSTONE CT
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7650
Practice Address - Country:US
Practice Address - Phone:248-982-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist