Provider Demographics
NPI:1831484021
Name:BELL, JASON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
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 1:10800 E 21ST ST N
Mailing Address - Street 2:T-1944
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3542
Mailing Address - Country:US
Mailing Address - Phone:316-636-4352
Mailing Address - Fax:
Practice Address - Street 1:10800 E 21ST ST N
Practice Address - Street 2:T-1944
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3542
Practice Address - Country:US
Practice Address - Phone:316-636-4352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist