Provider Demographics
NPI:1629693809
Name:BEITZEL, JASON M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:BEITZEL
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 1:24660 195TH ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6392
Mailing Address - Country:US
Mailing Address - Phone:563-599-7927
Mailing Address - Fax:
Practice Address - Street 1:5811 ELMORE AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3513
Practice Address - Country:US
Practice Address - Phone:563-359-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14310183500000X
IL051290343183500000X
IA19870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist