Healthcare Provider Details

I. General information

NPI: 1215863956
Provider Name (Legal Business Name): JASON DENNIS DOCTOR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-7203
  • Fax: 415-925-7219
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License Number83652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: