Healthcare Provider Details

I. General information

NPI: 1114200375
Provider Name (Legal Business Name): JASON D WILLIAMSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N ARROYO GRANDE BLVD
HENDERSON NV
89014-3974
US

IV. Provider business mailing address

401 N ARROYO GRANDE BLVD
HENDERSON NV
89014-3974
US

V. Phone/Fax

Practice location:
  • Phone: 702-436-7106
  • Fax:
Mailing address:
  • Phone: 702-436-7106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17474
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: