Provider Demographics
NPI:1033599386
Name:BEATTIE, JASON DANIEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:BEATTIE
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 1:6110 KESTRELRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4836
Mailing Address - Country:US
Mailing Address - Phone:813-746-2137
Mailing Address - Fax:
Practice Address - Street 1:202 E BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5221
Practice Address - Country:US
Practice Address - Phone:813-689-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist