Provider Demographics
NPI:1831611557
Name:ZHANG, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ZHANG
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 1:253 N NC 16 BUSINESS HWY APT 10
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-5006
Mailing Address - Country:US
Mailing Address - Phone:917-224-3821
Mailing Address - Fax:
Practice Address - Street 1:6300 MONROE WEDDINGTON RD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:NC
Practice Address - Zip Code:28104-7925
Practice Address - Country:US
Practice Address - Phone:704-843-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist