Provider Demographics
NPI:1770642589
Name:JASON KRAMER
Entity Type:Organization
Organization Name:JASON KRAMER
Other - Org Name:MIFFLINBURG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-966-5001
Mailing Address - Street 1:2 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-1323
Mailing Address - Country:US
Mailing Address - Phone:570-966-5001
Mailing Address - Fax:570-966-7046
Practice Address - Street 1:2 FOREST HILL RD
Practice Address - Street 2:
Practice Address - City:MIFFLINBURG
Practice Address - State:PA
Practice Address - Zip Code:17844-1323
Practice Address - Country:US
Practice Address - Phone:570-966-5001
Practice Address - Fax:570-966-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4813303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2086793OtherPK
PA1008428760001Medicaid
PA1008428760001Medicaid