MEDICARE: DR. THERESA C. JASO 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
1	1835P1200X	Pharmacotherapy Pharmacist	30240	TX

General Provider Information

NPI Number	:	1952399107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA C. JASO PHARM.D.

Provider Business Mailing Address
First Line	:	PO BOX 201233
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78720-1233
Country	:	US
Telephone Number	:	512-324-7680
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 E 15TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1930
Country	:	US
Telephone Number	:	512-324-7680
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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