MEDICARE: JASON PAK

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	19672	NV

General Provider Information

NPI Number	:	1841716917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON PAK

Provider Business Mailing Address
First Line	:	8925 W FLAMINGO RD UNIT 224
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2421 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3400
Country	:	US
Telephone Number	:	702-366-1556
Fax Number	:

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

Provider Enumeration Date	:	08/20/2017
Last Update Date	:	08/20/2017

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Directions to “ JASON PAK ” Practice Location

Language	Start Address	Practice Location

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