MEDICARE: DR. JENNIFER ROSE BEACH PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	PH00039934	WA

General Provider Information

NPI Number	:	1538126859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER ROSE BEACH PHARM.D.

Provider Business Mailing Address
First Line	:	8044 14TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-4329
Country	:	US
Telephone Number	:	206-985-6876
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 ROOSEVELT WAY NE
Second Line	:	SUITE 101
City	:	SEATTLE
State	:	WA
Zip	:	98105-6099
Country	:	US
Telephone Number	:	206-598-4985
Fax Number	:	206-598-4976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	07/08/2007

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