Provider Demographics
NPI:1447572433
Name:DEMERS, JASON CROSS (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CROSS
Last Name:DEMERS
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 1:511 STATE ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-2672
Mailing Address - Country:US
Mailing Address - Phone:315-393-6290
Mailing Address - Fax:315-394-0021
Practice Address - Street 1:511 STATE ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-2672
Practice Address - Country:US
Practice Address - Phone:315-393-6290
Practice Address - Fax:315-394-0021
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist