Provider Demographics
NPI:1174128425
Name:STRONG, JASON R (PHARM D)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:STRONG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6828
Mailing Address - Country:US
Mailing Address - Phone:601-853-1542
Mailing Address - Fax:
Practice Address - Street 1:726 E PEACE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4731
Practice Address - Country:US
Practice Address - Phone:601-859-3827
Practice Address - Fax:601-859-3829
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist