Provider Demographics
NPI:1619445996
Name:BEAL, JESSICA RACHAEL
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RACHAEL
Last Name:BEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 N BANANA RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-2546
Mailing Address - Country:US
Mailing Address - Phone:321-452-0010
Mailing Address - Fax:321-452-6716
Practice Address - Street 1:133 N BANANA RIVER DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-2546
Practice Address - Country:US
Practice Address - Phone:321-452-0010
Practice Address - Fax:321-452-6716
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist