Provider Demographics
NPI:1184079790
Name:STONE, JASON LEWIS (RPH)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:LEWIS
Last Name:STONE
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 1:94 PARK ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5401
Mailing Address - Country:US
Mailing Address - Phone:203-966-6758
Mailing Address - Fax:203-966-8785
Practice Address - Street 1:94 PARK ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5401
Practice Address - Country:US
Practice Address - Phone:203-966-6758
Practice Address - Fax:203-966-8785
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0004661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist