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General NPI Number Information
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NPI Number | 1063122596
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Entity Type | Individual
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Provider Name | JASON LEPORE
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Gender | Male
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 10/22/2023
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Provider Practice Location Address
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Address Line | 1045 ROBBINS RD
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2646
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Country | US
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Telephone | 616-844-0367
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Fax |
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Provider Business Mailing Address
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Address Line | 16972 TYSMAN WAY APT 301
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City | GRAND HAVEN
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State | MI
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Zip | 49417-8070
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Country | US
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Telephone | 705-943-2361
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302414766
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License Number State | MI
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