Provider Demographics
NPI:1255514105
Name:SMITH, JASON RICHARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:RICHARD
Last Name:SMITH
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 1:120 CORPORATE WOODS
Mailing Address - Street 2:SUITE 350 BOX 278983
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1471
Mailing Address - Country:US
Mailing Address - Phone:585-785-5193
Mailing Address - Fax:585-272-1062
Practice Address - Street 1:120 CORPORATE WOODS
Practice Address - Street 2:SUITE 350 BOX 278983
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1471
Practice Address - Country:US
Practice Address - Phone:585-785-5193
Practice Address - Fax:585-272-1062
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist