Provider Demographics
NPI:1831412048
Name:WILLIAMS, JASON MATTHEW (BS, RPH)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MATTHEW
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:BS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LARCH LN
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-5716
Mailing Address - Country:US
Mailing Address - Phone:570-885-0412
Mailing Address - Fax:
Practice Address - Street 1:2150 WILKES BARRE TOWNSHIP MARKET PL
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6059
Practice Address - Country:US
Practice Address - Phone:570-821-6190
Practice Address - Fax:570-821-6192
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044598R183500000X
MA23733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist