MEDICARE: JONATHAN EASON

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	PS51028	FL

General Provider Information

NPI Number	:	1952737769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN EASON

Provider Business Mailing Address
First Line	:	5851 TOSCANA DR
Second Line	:	APT 1736
City	:	DAVIE
State	:	FL
Zip	:	33314-3577
Country	:	US
Telephone Number	:	352-215-2058
Fax Number	:

Provider Business Practice Location Address
First Line	:	3102 GRIFFIN RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6286
Country	:	US
Telephone Number	:	954-961-1757
Fax Number	:

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

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	09/25/2013

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Directions to “ JONATHAN EASON ” Practice Location

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