Provider Demographics
NPI:1215182985
Name:MCKEWEN, JASON C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:MCKEWEN
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 1:602 CHARLESWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-1838
Mailing Address - Country:US
Mailing Address - Phone:870-739-2040
Mailing Address - Fax:
Practice Address - Street 1:200 W TYLER AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4223
Practice Address - Country:US
Practice Address - Phone:870-732-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD094811835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist