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NPI Code Detail

MEDICARE: JASON CHILDRESS

MEDICARE: JASON CHILDRESS
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
1183500000XPharmacist15596NC

General Provider Information

NPI Number : 1609271873
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON CHILDRESS
Provider Business Mailing Address
First Line : 8000 TOWN DR
Second Line :
City : RALEIGH
State : NC
Zip : 27616-2828
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8000 TOWN DR
Second Line :
City : RALEIGH
State : NC
Zip : 27616-2828
Country : US
Telephone Number : 919-424-6614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2014
Last Update Date : 10/29/2014

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Directions to “ JASON CHILDRESS ” Practice Location

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