Provider Demographics
NPI:1194066837
Name:GAUSE, JASON CARL (PHARMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:CARL
Last Name:GAUSE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 CROSSTOWN CARRIAGE WAY
Mailing Address - Street 2:#203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7051
Mailing Address - Country:US
Mailing Address - Phone:813-598-2574
Mailing Address - Fax:
Practice Address - Street 1:10335 CROSS CREEK BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2795
Practice Address - Country:US
Practice Address - Phone:813-973-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 49200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist