Healthcare Provider Details

I. General information

NPI: 1114275864
Provider Name (Legal Business Name): JASON BRENT BELL PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 LOVERS GAP RD
VANSANT VA
24656-9781
US

IV. Provider business mailing address

PO BOX 1096
VANSANT VA
24656-1096
US

V. Phone/Fax

Practice location:
  • Phone: 276-597-2520
  • Fax:
Mailing address:
  • Phone: 276-597-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202208487
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number014786
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: