Provider Demographics
NPI:1376827345
Name:VERTON, JASON PHILLIP (RPH)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:PHILLIP
Last Name:VERTON
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 1:401 BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4406
Mailing Address - Country:US
Mailing Address - Phone:618-344-6639
Mailing Address - Fax:
Practice Address - Street 1:401 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4406
Practice Address - Country:US
Practice Address - Phone:618-344-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051290188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist