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General NPI Number Information
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NPI Number | 1033712856
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Entity Type | Individual
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Provider Name | JASON AMEDEO CARR
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Gender | Male
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 15129 MADEIRA WAY
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City | MADEIRA BEACH
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State | FL
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Zip | 33708-1963
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Country | US
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Telephone | 727-397-5535
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Fax | 727-398-1049
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Provider Business Mailing Address
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Address Line | 15129 MADEIRA WAY
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City | MADEIRA BEACH
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State | FL
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Zip | 33708-1963
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Country | US
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Telephone | 727-397-5535
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Fax | 727-398-1049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS54069
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License Number State | FL
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