Provider Demographics
NPI:1821270117
Name:FOLCK, JASON ALAN
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALAN
Last Name:FOLCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8933 CONNEMARA LN
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9513
Mailing Address - Country:US
Mailing Address - Phone:716-741-8970
Mailing Address - Fax:
Practice Address - Street 1:1640 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1752
Practice Address - Country:US
Practice Address - Phone:716-568-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist