Provider Demographics
NPI:1861676314
Name:ERWIN, JASON J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:J
Last Name:ERWIN
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 1:11 FAIRMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1455
Mailing Address - Country:US
Mailing Address - Phone:518-792-0538
Mailing Address - Fax:518-812-0305
Practice Address - Street 1:RITE AID PHARMACY
Practice Address - Street 2:124 RIDGE ST
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-792-0538
Practice Address - Fax:518-812-0305
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist