Provider Demographics
NPI:1306449962
Name:ROZELL, JEREMY ALAN
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ALAN
Last Name:ROZELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3191 S DIXIE HWY APT 313
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-1593
Mailing Address - Country:US
Mailing Address - Phone:580-583-8876
Mailing Address - Fax:
Practice Address - Street 1:1800 W INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3900
Practice Address - Country:US
Practice Address - Phone:561-744-6822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65026183500000X
OK17736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist