Provider Demographics
NPI:1891123303
Name:KORNBLUM, JASON A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:KORNBLUM
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 1:40 OGDEN LN
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-2811
Mailing Address - Country:US
Mailing Address - Phone:908-839-6608
Mailing Address - Fax:
Practice Address - Street 1:425 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2519
Practice Address - Country:US
Practice Address - Phone:732-462-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03594300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist