Healthcare Provider Details

I. General information

NPI: 1508466962
Provider Name (Legal Business Name): JASON DWYER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TOBEY RD
WAREHAM MA
02571-1083
US

IV. Provider business mailing address

15 TOBEY RD
WAREHAM MA
02571-1083
US

V. Phone/Fax

Practice location:
  • Phone: 508-295-8822
  • Fax:
Mailing address:
  • Phone: 508-295-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH232896
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: