Provider Demographics
NPI:1497342000
Name:UNDERWOOD, JASON ELLIOTT (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ELLIOTT
Last Name:UNDERWOOD
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 1:182 FRANKFORT RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-9433
Mailing Address - Country:US
Mailing Address - Phone:502-437-3008
Mailing Address - Fax:502-437-3607
Practice Address - Street 1:182 FRANKFORT RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-9433
Practice Address - Country:US
Practice Address - Phone:502-437-3008
Practice Address - Fax:502-437-3607
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist