Provider Demographics
NPI:1285901447
Name:SEAVER, JASON WARD (RPH)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:WARD
Last Name:SEAVER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W RAAB RD
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1007
Mailing Address - Country:US
Mailing Address - Phone:309-454-7347
Mailing Address - Fax:309-454-3915
Practice Address - Street 1:505 W RAAB RD
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1007
Practice Address - Country:US
Practice Address - Phone:309-454-7347
Practice Address - Fax:309-454-3915
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14119183500000X
AL15212183500000X
IL051295405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist