Healthcare Provider Details

I. General information

NPI: 1598674020
Provider Name (Legal Business Name): JASON KROHN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 COWAN RD
GULFPORT MS
39507-3441
US

IV. Provider business mailing address

1110 COWAN RD
GULFPORT MS
39507-3441
US

V. Phone/Fax

Practice location:
  • Phone: 228-896-7070
  • Fax: 228-896-2843
Mailing address:
  • Phone: 228-896-7070
  • Fax: 228-896-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE09589
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: