Provider Demographics
NPI:1023169505
Name:ROYLANCE, JASON B (PHARM D)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:B
Last Name:ROYLANCE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 N CHERRY CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:UT
Mailing Address - Zip Code:84333-1741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84335-2302
Practice Address - Country:US
Practice Address - Phone:435-563-6201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5279126-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist