Provider Demographics
NPI:1386911477
Name:TROCKI, JASON EUGENE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:EUGENE
Last Name:TROCKI
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 1:5896 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2703
Mailing Address - Country:US
Mailing Address - Phone:941-792-3817
Mailing Address - Fax:
Practice Address - Street 1:5896 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2703
Practice Address - Country:US
Practice Address - Phone:941-792-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2013-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444092183500000X
FLPS46897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist