Provider Demographics
NPI:1629334875
Name:MYER, JASON W (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:W
Last Name:MYER
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 1:202 SIEMERS DR
Mailing Address - Street 2:T-0992
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-8419
Mailing Address - Country:US
Mailing Address - Phone:573-334-6578
Mailing Address - Fax:573-290-3566
Practice Address - Street 1:202 SIEMERS DR
Practice Address - Street 2:T-0992
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-8419
Practice Address - Country:US
Practice Address - Phone:573-334-6578
Practice Address - Fax:573-290-3566
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005030408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist