Jason Rasoul
Individual provider Active NPI Pharmacist · Butler, WI
NPI 1972973162 · NPPES record last updated Sep 30, 2015
Key facts
- NPI
- 1972973162
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 15029-040 (WI)
- Practice address
- 12601 W Hampton Ave
Butler, WI 53007-1730 - Phone
- (262) 781-0148
- NPI assigned
- Sep 30, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15029-040 | WI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 15029-040 | WI | Yes |
Addresses
Primary practice location
12601 W Hampton Ave
Butler, WI 53007-1730
Mailing address
12601 W Hampton Ave
Butler, WI 53007-1730
Other providers in Butler, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.