Provider Demographics
NPI:1568739258
Name:PATRON, JASON CYRIL (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CYRIL
Last Name:PATRON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:CYRIL
Other - Last Name:TIXIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5659
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS
Mailing Address - State:AZ
Mailing Address - Zip Code:85349-5659
Mailing Address - Country:US
Mailing Address - Phone:928-276-1243
Mailing Address - Fax:928-722-7290
Practice Address - Street 1:1613 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85336-0667
Practice Address - Country:US
Practice Address - Phone:928-722-7288
Practice Address - Fax:928-722-7290
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021643183500000X
CO18052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS021643OtherPHARMACIST LICENSE