MEDICARE: JASON CAVINESS RPH

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	18545	CO
2	183500000X	Pharmacist	S019365	AZ

General Provider Information

NPI Number	:	1720361371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON CAVINESS RPH

Provider Business Mailing Address
First Line	:	3411 N 16TH ST
Second Line	:	APT 2035
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7150
Country	:	US
Telephone Number	:	507-227-0536
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 NORTH 16TH STREET
Second Line	:	APT 2035
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5995
Country	:	US
Telephone Number	:	507-227-0536
Fax Number	:

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

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/12/2013

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Directions to “ JASON CAVINESS RPH” Practice Location

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