Provider Demographics
NPI:1760906952
Name:NADEAU, JASON (RPH)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:NADEAU
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 1:1339 ST JOHN RD
Mailing Address - Street 2:
Mailing Address - City:ST JOHN PLT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-4002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:429 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1082
Practice Address - Country:US
Practice Address - Phone:207-728-3815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist