Provider Demographics
NPI:1215280714
Name:SLOOF, JACQUELINE NICOLE (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:NICOLE
Last Name:SLOOF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12013 LAKE CYPRESS CIR
Mailing Address - Street 2:APT D303
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7075
Mailing Address - Country:US
Mailing Address - Phone:321-412-5562
Mailing Address - Fax:
Practice Address - Street 1:3235 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-3723
Practice Address - Country:US
Practice Address - Phone:407-649-7859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist