Provider Demographics
NPI:1427654987
Name:SHOLOM, JACQUELINE (PHARMD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SHOLOM
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 1:7546 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1007
Mailing Address - Country:US
Mailing Address - Phone:561-843-5387
Mailing Address - Fax:
Practice Address - Street 1:4145 NW 53RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4404
Practice Address - Country:US
Practice Address - Phone:352-371-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55966333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy