Provider Demographics
NPI:1922355080
Name:HALE, JASON DEAN (RPH)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DEAN
Last Name:HALE
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 1:3020 HAMMONS FORK RD
Mailing Address - Street 2:
Mailing Address - City:WOOLLUM
Mailing Address - State:KY
Mailing Address - Zip Code:40906-8730
Mailing Address - Country:US
Mailing Address - Phone:606-546-3020
Mailing Address - Fax:606-546-3020
Practice Address - Street 1:1019 CUMBERLAND FALLS HWY
Practice Address - Street 2:KROGER PHARMACY
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701
Practice Address - Country:US
Practice Address - Phone:606-526-0755
Practice Address - Fax:606-526-9589
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014450183500000X
IN26019879A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist