Provider Demographics
NPI:1003070616
Name:ROE, JASON NATHANIEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:NATHANIEL
Last Name:ROE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2511
Mailing Address - Country:US
Mailing Address - Phone:561-683-6966
Mailing Address - Fax:561-683-6966
Practice Address - Street 1:6901 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BCH
Practice Address - State:FL
Practice Address - Zip Code:33411-2511
Practice Address - Country:US
Practice Address - Phone:561-683-6966
Practice Address - Fax:561-683-6966
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist