Provider Demographics
NPI:1932430931
Name:CARLE, JASON CONNELLY JR (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:CONNELLY
Last Name:CARLE
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 W SOUTHERN AVE
Mailing Address - Street 2:LOT 399
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4206
Mailing Address - Country:US
Mailing Address - Phone:602-438-4057
Mailing Address - Fax:
Practice Address - Street 1:8280 W LOWER BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-7405
Practice Address - Country:US
Practice Address - Phone:623-936-6638
Practice Address - Fax:623-936-9034
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist