Provider Demographics
NPI:1306175146
Name:MANCE, JASON (PHARMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MANCE
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 1:6911 RR 620 N
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-1920
Mailing Address - Country:US
Mailing Address - Phone:512-219-8533
Mailing Address - Fax:512-219-8529
Practice Address - Street 1:6911 RR 620 N
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-1920
Practice Address - Country:US
Practice Address - Phone:512-219-8533
Practice Address - Fax:512-219-8529
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist