Provider Demographics
NPI:1780249516
Name:SUTTON, JASON BRANSON (DPH AND RPH)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:BRANSON
Last Name:SUTTON
Suffix:
Gender:M
Credentials:DPH AND RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 ESSEX DR # 200
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-9714
Mailing Address - Country:US
Mailing Address - Phone:214-765-5456
Mailing Address - Fax:
Practice Address - Street 1:3313 ESSEX DR # 200
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-9714
Practice Address - Country:US
Practice Address - Phone:214-765-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX570861835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric