Individual provider Active NPI

Jason Edward Haberer, PHARMD

  • Pharmacist
  • Tulsa, OK
National Provider Identifier
1245824416
Registry record updated May 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
17663 Issued in OK
Practice address
744 W 9TH St FL 6
Tulsa, OK 74127-9907
Phone
(479) 651-7711
NPI assigned
Feb 27, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 17663 OK Primary

Addresses

Primary practice location

744 W 9TH St FL 6
Tulsa, OK 74127-9907

Mailing address

7431 S 225TH East Ave
Broken Arrow, OK 74014-2421

Other practice location 1

1120 S Utica Ave
Tulsa, OK 74104-4012
Phone (918) 579-7400

Other identifiers 1

IdentifierTypeStateIssuer
17663OtherOKOKLAHOMA STATE BOARD OF PHARMACY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
17663OKMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622419200000",
    "number": "1245824416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7431 S 225TH EAST AVE",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740142421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 W 9TH ST FL 6",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741279907",
            "telephone_number": "479-651-7711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 S Utica Ave",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741044012",
            "country_code": "US",
            "telephone_number": "918-579-7400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HABERER",
        "first_name": "JASON",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-27",
        "last_updated": "2021-05-31",
        "certification_date": "2021-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OK",
            "license": "17663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA STATE BOARD OF PHARMACY",
            "identifier": "17663",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.