Healthcare Provider Details

I. General information

NPI: 1376719195
Provider Name (Legal Business Name): GASTON J-M BEDARD PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 5TH ST N
ST PETERSBURG FL
33701-2812
US

IV. Provider business mailing address

4249 EAGLE WATCH BLVD
PALM HARBOR FL
34685-3318
US

V. Phone/Fax

Practice location:
  • Phone: 727-892-5781
  • Fax: 727-892-5783
Mailing address:
  • Phone: 727-789-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS21574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: