Provider Demographics
NPI:1639347313
Name:REVEL, JASON ROBERT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROBERT
Last Name:REVEL
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 1:5601 NW 72ND ST STE 242
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5923
Mailing Address - Country:US
Mailing Address - Phone:888-773-8266
Mailing Address - Fax:888-998-8267
Practice Address - Street 1:5601 NW 72ND ST STE 242
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-5923
Practice Address - Country:US
Practice Address - Phone:888-773-8266
Practice Address - Fax:888-998-8267
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13915183500000X
MO2004032893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist