Provider Demographics
NPI:1750966263
Name:PRISCO, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PRISCO
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 1:255 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-2922
Mailing Address - Country:US
Mailing Address - Phone:973-448-9051
Mailing Address - Fax:
Practice Address - Street 1:255 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828-2922
Practice Address - Country:US
Practice Address - Phone:973-448-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03817500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist