1508429689 NPI number — JASON SCOTT WILLIAMS PHARMD

Table of content: JASON SCOTT WILLIAMS PHARMD (NPI 1508429689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508429689 NPI number — JASON SCOTT WILLIAMS PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
JASON
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
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:
1508429689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2314 76TH AVENUE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREELEY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80634-7410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-760-8497
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3247 23RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80620-1733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-330-5739
Provider Business Practice Location Address Fax Number:
970-330-6050
Provider Enumeration Date:
04/15/2019

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:  16927 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 16927 . This is a "COLORADO STATE BOARD OF PHARMACY" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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