Healthcare Provider Details

I. General information

NPI: 1083382519
Provider Name (Legal Business Name): JASON N MARDIS CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28550 HIGHWAY 290
CYPRESS TX
77433-4288
US

IV. Provider business mailing address

28550 HIGHWAY 290
CYPRESS TX
77433-4288
US

V. Phone/Fax

Practice location:
  • Phone: 281-256-6490
  • Fax: 281-256-6546
Mailing address:
  • Phone: 281-256-6490
  • Fax: 281-256-6546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number203163
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: