Provider Demographics
NPI:1205393485
Name:BEVEL, JODIE (RPH)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:BEVEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W GRANADA BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2304
Mailing Address - Country:US
Mailing Address - Phone:386-672-0600
Mailing Address - Fax:
Practice Address - Street 1:500 W GRANADA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-2304
Practice Address - Country:US
Practice Address - Phone:386-672-0600
Practice Address - Fax:386-672-0700
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS15319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist