Provider Demographics
NPI:1124622238
Name:SKELTON, JARED LAMAR (PHARMD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:LAMAR
Last Name:SKELTON
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 1:5029 FAIRCLOTH ST
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-2705
Mailing Address - Country:US
Mailing Address - Phone:678-628-8209
Mailing Address - Fax:
Practice Address - Street 1:6501 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4582
Practice Address - Country:US
Practice Address - Phone:850-623-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist