Provider Demographics
NPI:1225385206
Name:STUBBLEFIELD, JASON ANDREW (PHARMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ANDREW
Last Name:STUBBLEFIELD
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 1:8525 OLD COUNTRY MNR
Mailing Address - Street 2:APT 509
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2918
Mailing Address - Country:US
Mailing Address - Phone:954-292-3385
Mailing Address - Fax:
Practice Address - Street 1:4529 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2006
Practice Address - Country:US
Practice Address - Phone:954-480-9132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist