Provider Demographics
NPI:1942580410
Name:GABLE, JASON (RPH)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:GABLE
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 1:1910 S REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1438
Mailing Address - Country:US
Mailing Address - Phone:419-867-3529
Mailing Address - Fax:419-867-3885
Practice Address - Street 1:1910 S REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1438
Practice Address - Country:US
Practice Address - Phone:419-867-3529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03226416183500000X
MI5302035818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist