Provider Demographics
NPI:1346494317
Name:TEWELL, JASON DOUGLAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DOUGLAS
Last Name:TEWELL
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 1:989 LOS OSOS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3205
Mailing Address - Country:US
Mailing Address - Phone:805-528-1017
Mailing Address - Fax:805-528-1915
Practice Address - Street 1:989 LOS OSOS VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3205
Practice Address - Country:US
Practice Address - Phone:805-528-1017
Practice Address - Fax:805-528-1915
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist