Provider Demographics
NPI:1710073283
Name:CARTER, JASON DANIEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DANIEL
Last Name:CARTER
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 1:2403 CARDINAL LANE
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0001
Mailing Address - Country:US
Mailing Address - Phone:918-647-2349
Mailing Address - Fax:918-647-2359
Practice Address - Street 1:307 NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953
Practice Address - Country:US
Practice Address - Phone:918-647-2349
Practice Address - Fax:918-647-2359
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13679282NR1301X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No282NR1301XHospitalsGeneral Acute Care HospitalRural