Healthcare Provider Details

I. General information

NPI: 1780959841
Provider Name (Legal Business Name): MR. JASON N BEDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 NORTHLAKE BLVD
PALM BEACH GARDENS FL
33403-1702
US

IV. Provider business mailing address

3250 NORTHLAKE BLVD
PALM BEACH GARDENS FL
33403-1702
US

V. Phone/Fax

Practice location:
  • Phone: 561-776-3037
  • Fax: 561-776-3046
Mailing address:
  • Phone: 561-776-3037
  • Fax: 561-776-3046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS24482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: