Healthcare Provider Details

I. General information

NPI: 1750217600
Provider Name (Legal Business Name): JASON GRATEROL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E WASHINGTON ST APT 207
SYRACUSE NY
13202-1514
US

IV. Provider business mailing address

300 E WASHINGTON ST APT 207
SYRACUSE NY
13202-1514
US

V. Phone/Fax

Practice location:
  • Phone: 240-424-1558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: