Provider Demographics
NPI:1487259230
Name:ELROD, JASON ALEXANDER (PHARMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ALEXANDER
Last Name:ELROD
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 1:102 SAPPHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-7002
Mailing Address - Country:US
Mailing Address - Phone:508-365-8060
Mailing Address - Fax:
Practice Address - Street 1:119 BULL ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-3312
Practice Address - Country:US
Practice Address - Phone:912-232-1129
Practice Address - Fax:912-238-3733
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist