MEDICARE: MR. JASON TODD TROMBLEY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	047501-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1316964489	OTHER	NY	NPI

General Provider Information

NPI Number	:	1164605176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON TODD TROMBLEY RPH

Provider Business Mailing Address
First Line	:	3018 EAST AVE
Second Line	:
City	:	CENTRAL SQUARE
State	:	NY
Zip	:	13036-2615
Country	:	US
Telephone Number	:	315-668-0413
Fax Number	:	315-668-0415

Provider Business Practice Location Address
First Line	:	3018 EAST AVE
Second Line	:
City	:	CENTRAL SQUARE
State	:	NY
Zip	:	13036-2615
Country	:	US
Telephone Number	:	315-668-0413
Fax Number	:	315-668-0415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	12/12/2007

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