Provider Demographics
NPI:1538519392
Name:NEILSON, JASE R (PHARM D)
Entity Type:Individual
Prefix:
First Name:JASE
Middle Name:R
Last Name:NEILSON
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 1:633 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3548
Mailing Address - Country:US
Mailing Address - Phone:435-586-1043
Mailing Address - Fax:
Practice Address - Street 1:633 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3548
Practice Address - Country:US
Practice Address - Phone:435-586-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8284516-1701183500000X
NV19281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist