=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700288438
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON HUNSAKER PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2014
-----------------------------------------------------
Last Update Date | 03/31/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 980 PARK AVE NW
-----------------------------------------------------
City | NORTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24273-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-393-0428
-----------------------------------------------------
Fax | 276-212-0212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5752 POWELL VALLEY RD
-----------------------------------------------------
City | BIG STONE GAP
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24219-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-393-0428
-----------------------------------------------------
Fax | 276-212-0212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 21702
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------