Provider Demographics
NPI:1427754118
Name:CATASUS, JACKLYN HARGRAVES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACKLYN
Middle Name:HARGRAVES
Last Name:CATASUS
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 1:134 WATERWAY RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1543
Mailing Address - Country:US
Mailing Address - Phone:561-308-2507
Mailing Address - Fax:
Practice Address - Street 1:39200 HOOKER HWY STE 101
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-5368
Practice Address - Country:US
Practice Address - Phone:561-209-2580
Practice Address - Fax:844-800-4326
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist