Provider Demographics
NPI:1821373077
Name:WANG, JASON ALEXANDER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALEXANDER
Last Name:WANG
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 1:8640 COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PEVELY
Mailing Address - State:MO
Mailing Address - Zip Code:63070-1529
Mailing Address - Country:US
Mailing Address - Phone:636-479-6100
Mailing Address - Fax:636-479-6101
Practice Address - Street 1:8640 COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:PEVELY
Practice Address - State:MO
Practice Address - Zip Code:63070-1529
Practice Address - Country:US
Practice Address - Phone:636-479-6100
Practice Address - Fax:636-479-6101
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011020707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist