Provider Demographics
NPI:1215262308
Name:WYRICK, JASON CHAD (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHAD
Last Name:WYRICK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 OLD CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-6612
Mailing Address - Country:US
Mailing Address - Phone:704-932-0235
Mailing Address - Fax:
Practice Address - Street 1:1605 E INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-6022
Practice Address - Country:US
Practice Address - Phone:704-630-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist