Provider Demographics
NPI:1386409282
Name:JASE PHARMACIES LLC
Entity type:Organization
Organization Name:JASE PHARMACIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-673-6283
Mailing Address - Street 1:6142 W 9790 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5604
Mailing Address - Country:US
Mailing Address - Phone:888-861-3632
Mailing Address - Fax:
Practice Address - Street 1:6142 W 9790 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-5604
Practice Address - Country:US
Practice Address - Phone:888-861-3632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy