Provider Demographics
NPI:1285915637
Name:SIFAKIS, JESSICA CLACK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:CLACK
Last Name:SIFAKIS
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 1:1370 13TH AVE S, MOB A, STE 118
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3206
Mailing Address - Country:US
Mailing Address - Phone:904-376-3534
Mailing Address - Fax:904-202-4639
Practice Address - Street 1:841 PRUDENTIAL DR STE 180
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8350
Practice Address - Country:US
Practice Address - Phone:904-202-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist