Provider Demographics
NPI:1588963037
Name:BURNETT, JEANPAUL MARGAIN (PHARMD)
Entity type:Individual
Prefix:
First Name:JEANPAUL
Middle Name:MARGAIN
Last Name:BURNETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2864 SCOTT MILL TER
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5756
Mailing Address - Country:US
Mailing Address - Phone:904-655-6260
Mailing Address - Fax:
Practice Address - Street 1:2261 EDGEWOOD AVE W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-2554
Practice Address - Country:US
Practice Address - Phone:904-924-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist