1255514105 NPI number — DR. JASON RICHARD SMITH PHARMD

Table of content: DR. JASON RICHARD SMITH PHARMD (NPI 1255514105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255514105 NPI number — DR. JASON RICHARD SMITH PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
JASON
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255514105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 CORPORATE WOODS
Provider Second Line Business Mailing Address:
SUITE 350 BOX 278983
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14623-1471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-785-5193
Provider Business Mailing Address Fax Number:
585-272-1062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 CORPORATE WOODS
Provider Second Line Business Practice Location Address:
SUITE 350 BOX 278983
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14623-1471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-785-5193
Provider Business Practice Location Address Fax Number:
585-272-1062
Provider Enumeration Date:
12/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  048646 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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