Healthcare Provider Details

I. General information

NPI: 1659915510
Provider Name (Legal Business Name): JASON MADARIAGA CUARESMA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PARKWAY DR NE
ATLANTA GA
30312-1212
US

IV. Provider business mailing address

2859 FAIRLANE DR
DORAVILLE GA
30340-3229
US

V. Phone/Fax

Practice location:
  • Phone: 404-265-3514
  • Fax:
Mailing address:
  • Phone: 619-502-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH031721
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: