Provider Demographics
NPI:1730464983
Name:WAHL, JASON ROBERT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROBERT
Last Name:WAHL
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 1:1311 W SAM HOUSTON PKWY N STE 130
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-4015
Mailing Address - Country:US
Mailing Address - Phone:800-511-5144
Mailing Address - Fax:877-541-1503
Practice Address - Street 1:1311 W SAM HOUSTON PKWY N STE 130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-4015
Practice Address - Country:US
Practice Address - Phone:800-511-5144
Practice Address - Fax:877-541-1503
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist