Healthcare Provider Details

I. General information

NPI: 1942194469
Provider Name (Legal Business Name): JASON SCOT SMITH PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4142 PACIFIC COAST HWY
TORRANCE CA
90505-5714
US

IV. Provider business mailing address

4142 PACIFIC COAST HWY
TORRANCE CA
90505-5714
US

V. Phone/Fax

Practice location:
  • Phone: 424-702-9721
  • Fax:
Mailing address:
  • Phone: 424-702-9721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number199742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: