Provider Demographics
NPI:1386038321
Name:GHIO, JASON MAX (PHARM D)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MAX
Last Name:GHIO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7903
Mailing Address - Country:US
Mailing Address - Phone:662-892-3031
Mailing Address - Fax:
Practice Address - Street 1:5150 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7903
Practice Address - Country:US
Practice Address - Phone:662-892-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38332183500000X
MSE-13638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist