Provider Demographics
NPI:1508429689
Name:WILLIAMS, JASON SCOTT (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:SCOTT
Last Name:WILLIAMS
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 1:2314 76TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7410
Mailing Address - Country:US
Mailing Address - Phone:307-760-8497
Mailing Address - Fax:
Practice Address - Street 1:3247 23RD AVE
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:CO
Practice Address - Zip Code:80620-1733
Practice Address - Country:US
Practice Address - Phone:970-330-5739
Practice Address - Fax:970-330-6050
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16927OtherCOLORADO STATE BOARD OF PHARMACY