MEDICARE: DR. JASON ROBERT WAHL PHARMD

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	48988	TX

General Provider Information

NPI Number	:	1730464983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON ROBERT WAHL PHARMD

Provider Business Mailing Address
First Line	:	1311 W SAM HOUSTON PKWY N STE 130
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-4015
Country	:	US
Telephone Number	:	800-511-5144
Fax Number	:	877-541-1503

Provider Business Practice Location Address
First Line	:	1311 W SAM HOUSTON PKWY N STE 130
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-4015
Country	:	US
Telephone Number	:	800-511-5144
Fax Number	:	877-541-1503

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

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	05/10/2017

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