MEDICARE: JASON EDWARD THILL PHARM-D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302033370	MI

General Provider Information

NPI Number	:	1598910861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON EDWARD THILL PHARM-D

Provider Business Mailing Address
First Line	:	5091 US 41 S
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-9001
Country	:	US
Telephone Number	:	906-249-1441
Fax Number	:	906-249-9850

Provider Business Practice Location Address
First Line	:	5091 US 41 S
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-9001
Country	:	US
Telephone Number	:	906-249-1441
Fax Number	:	906-249-9850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2008
Last Update Date	:	11/29/2008

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