Provider Demographics
NPI:1376719195
Name:BEDARD, GASTON J-M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GASTON
Middle Name:J-M
Last Name:BEDARD
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 1:4249 EAGLE WATCH BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3318
Mailing Address - Country:US
Mailing Address - Phone:727-789-1725
Mailing Address - Fax:
Practice Address - Street 1:330 5TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2812
Practice Address - Country:US
Practice Address - Phone:727-892-5781
Practice Address - Fax:727-892-5783
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS215741835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist