Provider Demographics
NPI:1013460302
Name:MCCOMB, JASON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MCCOMB
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 1:9738 S VIRGINIA ST
Mailing Address - Street 2:STE F
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-5930
Mailing Address - Country:US
Mailing Address - Phone:775-853-3502
Mailing Address - Fax:775-236-5771
Practice Address - Street 1:9738 S VIRGINIA ST
Practice Address - Street 2:STE F
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-5930
Practice Address - Country:US
Practice Address - Phone:775-853-3502
Practice Address - Fax:775-236-5771
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17364183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric