Provider Demographics
NPI:1295134815
Name:KING, JASON BELVARD (PHARMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:BELVARD
Last Name:KING
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 1:2701 LOUISVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6128
Mailing Address - Country:US
Mailing Address - Phone:318-361-0690
Mailing Address - Fax:318-388-4349
Practice Address - Street 1:2701 LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6128
Practice Address - Country:US
Practice Address - Phone:318-361-0690
Practice Address - Fax:318-388-4349
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist