Provider Demographics
NPI:1023485166
Name:WHEAT, JASON (PHARMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:WHEAT
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 1:2096 SHAWNEE LN
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:TN
Mailing Address - Zip Code:37073-4120
Mailing Address - Country:US
Mailing Address - Phone:615-335-0551
Mailing Address - Fax:
Practice Address - Street 1:3360 TOM AUSTIN HWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-4516
Practice Address - Country:US
Practice Address - Phone:615-384-7348
Practice Address - Fax:615-384-2011
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist