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General NPI Number Information
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NPI Number | 1205393485
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Entity Type | Individual
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Provider Name | JODIE BEVEL RPH
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Gender | Male
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 500 W GRANADA BLVD STE 4
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City | ORMOND BEACH
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State | FL
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Zip | 32174-2304
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Country | US
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Telephone | 386-672-0600
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Fax | 386-672-0700
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Provider Business Mailing Address
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Address Line | 500 W GRANADA BLVD STE 4
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City | ORMOND BEACH
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State | FL
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Zip | 32174-2304
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Country | US
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Telephone | 386-672-0600
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Fax |
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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 | PS15319
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License Number State | FL
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