Provider Demographics
NPI:1831260074
Name:ENDERS, JASON PAUL (PHARMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:ENDERS
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 1:210 BANCROFT PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-1737
Mailing Address - Country:US
Mailing Address - Phone:402-346-8030
Mailing Address - Fax:
Practice Address - Street 1:2701 S 10TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1610
Practice Address - Country:US
Practice Address - Phone:402-342-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47060386000Medicaid
NE47060386000Medicaid