Healthcare Provider Details

I. General information

NPI: 1174738330
Provider Name (Legal Business Name): JASON ROBERT JOKERST PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 WEBBERVILLE RD
AUSTIN TX
78702-2947
US

IV. Provider business mailing address

202 W CRESTLAND DR
AUSTIN TX
78752-2428
US

V. Phone/Fax

Practice location:
  • Phone: 512-972-4394
  • Fax:
Mailing address:
  • Phone: 402-714-3327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number43696
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: