MEDICARE: DR. JASON NATHANIEL ROE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS40255	FL

General Provider Information

NPI Number	:	1003070616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON NATHANIEL ROE PHARMD

Provider Business Mailing Address
First Line	:	6901 OKEECHOBEE BLVD
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33411-2511
Country	:	US
Telephone Number	:	561-683-6966
Fax Number	:	561-683-6966

Provider Business Practice Location Address
First Line	:	6901 OKEECHOBEE BLVD
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33411-2511
Country	:	US
Telephone Number	:	561-683-6966
Fax Number	:	561-683-6966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2008
Last Update Date	:	07/12/2008

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