Provider Demographics
NPI:1336199223
Name:WETHINGTON, JASPER WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JASPER
Middle Name:WAYNE
Last Name:WETHINGTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6200 ROCKHILL CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-6713
Mailing Address - Country:US
Mailing Address - Phone:907-230-4801
Mailing Address - Fax:907-743-7257
Practice Address - Street 1:4951 BUSINESS PARK BOULEVARD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7174
Practice Address - Country:US
Practice Address - Phone:907-743-7203
Practice Address - Fax:907-743-7257
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist