Basic Information
| Provider Information | |||||||||
| NPI: | 1629693809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEITZEL | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24660 195TH ST | ||||||||
| Address2: | |||||||||
| City: | BETTENDORF | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527226392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5635997927 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5811 ELMORE AVE | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528073513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633594874 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2020 | ||||||||
| LastUpdateDate: | 06/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 14310 | WI | N | Pharmacy Service Providers | Pharmacist | 183500000X | 051290343 | IL | N | Pharmacy Service Providers | Pharmacist | 183500000X | 19870 | IA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.