Provider Demographics
NPI:1871264721
Name:AUDETTE, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:AUDETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-3222
Mailing Address - Country:US
Mailing Address - Phone:305-751-6366
Mailing Address - Fax:
Practice Address - Street 1:9050 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-3222
Practice Address - Country:US
Practice Address - Phone:305-751-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI41891183700000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician