Provider Demographics
NPI:1952685190
Name:WOOD, JASON M (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:WOOD
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 1:105 CHRISTINA LANDING DR
Mailing Address - Street 2:APT 2006
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-5200
Mailing Address - Country:US
Mailing Address - Phone:856-979-4859
Mailing Address - Fax:
Practice Address - Street 1:230 S BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-2724
Practice Address - Country:US
Practice Address - Phone:856-678-2224
Practice Address - Fax:856-678-5102
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03151800183500000X
DEA10003401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist