Individual ProviderJason GardnerPharmacistPharmacy Service ProvidersPractice Address104 Jay St, Brooklyn, NY 11201-1569(718) 246-4100PECOS EnrollmentBased on the most recent information from CMS, provider Jason Gardner does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1427371939Provider TypeIndividualFull NameGardner, JasonCredentialR.PH.GenderMaleSole ProprietorYesEnumeration Date3/11/2010Last Updated2/21/2014Contact InformationPractice LocationPractice Address104 Jay St, Brooklyn, NY 11201-1569Phone(718) 246-4100Fax(718) 246-2417Mailing LocationMailing Address104 Jay St, Brooklyn, NY 11201-1569Phone(718) 246-4100Fax(718) 246-2417Provider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicense050651New YorkCode183500000XDescriptionPharmacistPharmacy Service ProvidersLicense9464South CarolinaCode183500000XDescriptionPharmacistPharmacy Service ProvidersLicense16298Louisiana