Provider Demographics
NPI:1396082913
Name:GRACE, JERHONDA JANEE (PHARMD)
Entity type:Individual
Prefix:
First Name:JERHONDA
Middle Name:JANEE
Last Name:GRACE
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 1:16831 SW 111TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4098
Mailing Address - Country:US
Mailing Address - Phone:305-684-8668
Mailing Address - Fax:305-238-7624
Practice Address - Street 1:12100 SW 127TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4663
Practice Address - Country:US
Practice Address - Phone:305-238-1019
Practice Address - Fax:305-238-7624
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist