Provider Demographics
NPI:1780959841
Name:BEDEN, JASON N
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:N
Last Name:BEDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1702
Mailing Address - Country:US
Mailing Address - Phone:561-776-3037
Mailing Address - Fax:561-776-3046
Practice Address - Street 1:3250 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1702
Practice Address - Country:US
Practice Address - Phone:561-776-3037
Practice Address - Fax:561-776-3046
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist