Provider Demographics
NPI:1710974621
Name:JASION, MARTIN (RPH)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:JASION
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3707
Mailing Address - Country:US
Mailing Address - Phone:908-203-8555
Mailing Address - Fax:
Practice Address - Street 1:1990 WASHINGTON VALLEY RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08836-2057
Practice Address - Country:US
Practice Address - Phone:732-469-0777
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist