Provider Demographics
NPI:1669023727
Name:HARTING, JASON DREW
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DREW
Last Name:HARTING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 S CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3721
Mailing Address - Country:US
Mailing Address - Phone:801-996-9008
Mailing Address - Fax:
Practice Address - Street 1:3747 S CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84119-3721
Practice Address - Country:US
Practice Address - Phone:801-996-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy