Provider Demographics
NPI:1235731795
Name:KASIAR, JASON VINCENT (R PH)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:VINCENT
Last Name:KASIAR
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-1629
Mailing Address - Country:US
Mailing Address - Phone:618-313-2238
Mailing Address - Fax:618-273-5328
Practice Address - Street 1:1409 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-1629
Practice Address - Country:US
Practice Address - Phone:618-313-2238
Practice Address - Fax:618-273-8111
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist