Provider Demographics
NPI:1811724313
Name:FOHL, JASON (PHARM D)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:FOHL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-2604
Mailing Address - Country:US
Mailing Address - Phone:765-825-6251
Mailing Address - Fax:
Practice Address - Street 1:330 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2604
Practice Address - Country:US
Practice Address - Phone:765-825-6251
Practice Address - Fax:765-825-6386
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020525A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist