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NPI Code Detail

MEDICARE: DR. JASON O'NEAL PHARM.D.

MEDICARE: DR. JASON O'NEAL PHARM.D.
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
1183500000XPharmacist14970OK

General Provider Information

NPI Number : 1255614509
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON O'NEAL PHARM.D.
Provider Business Mailing Address
First Line : 3209 S 18TH ST
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-1809
Country : US
Telephone Number : 918-289-5660
Fax Number :
Provider Business Practice Location Address
First Line : 1305 W CHEROKEE ST
Second Line :
City : WAGONER
State : OK
Zip : 74467-4625
Country : US
Telephone Number : 918-485-6688
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2011
Last Update Date : 09/22/2011

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