Provider Demographics
NPI:1366780769
Name:GAWLER, JAY
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:GAWLER
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 1:4145 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-4804
Mailing Address - Country:US
Mailing Address - Phone:772-299-6245
Mailing Address - Fax:772-299-6270
Practice Address - Street 1:4145 9TH ST SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-4804
Practice Address - Country:US
Practice Address - Phone:772-299-6245
Practice Address - Fax:772-299-6270
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS14756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0014756OtherLICENSE NO
NJPS14756OtherLICRNSE NO