Provider Demographics
NPI:1932662236
Name:SMITH, JASON CHRISTOPHER (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 STEPHENS RD STE G
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-4340
Mailing Address - Country:US
Mailing Address - Phone:734-656-4082
Mailing Address - Fax:877-899-6360
Practice Address - Street 1:13201 STEPHENS RD STE G
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-4340
Practice Address - Country:US
Practice Address - Phone:734-656-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist