Provider Demographics
NPI:1114275864
Name:BELL, JASON BRENT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRENT
Last Name:BELL
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:PO BOX 1096
Mailing Address - Street 2:
Mailing Address - City:VANSANT
Mailing Address - State:VA
Mailing Address - Zip Code:24656-1096
Mailing Address - Country:US
Mailing Address - Phone:276-597-2520
Mailing Address - Fax:
Practice Address - Street 1:1755 LOVERS GAP RD
Practice Address - Street 2:
Practice Address - City:VANSANT
Practice Address - State:VA
Practice Address - Zip Code:24656-9781
Practice Address - Country:US
Practice Address - Phone:276-597-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208487183500000X
KY014786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist