MEDICARE: JENNIFER T AVESON RPH

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	13536	SC
2	183500000X	Pharmacist	0202012200	VA

General Provider Information

NPI Number	:	1497004915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER T AVESON RPH

Provider Business Mailing Address
First Line	:	1512 HOLLY DR
Second Line	:	UNIT 104
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-4089
Country	:	US
Telephone Number	:	804-400-3843
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 HIGHWAY 17 N
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-6024
Country	:	US
Telephone Number	:	843-238-5628
Fax Number	:

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

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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Directions to “ JENNIFER T AVESON RPH” Practice Location

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