Provider Demographics
NPI:1902401870
Name:MEYLER, THANDIWE JOLLY (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:THANDIWE
Middle Name:JOLLY
Last Name:MEYLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:THANDIWE
Other - Middle Name:JOLLY
Other - Last Name:MEYLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1300 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2109
Mailing Address - Country:US
Mailing Address - Phone:772-878-7078
Mailing Address - Fax:772-343-0608
Practice Address - Street 1:1300 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2109
Practice Address - Country:US
Practice Address - Phone:772-878-7078
Practice Address - Fax:772-343-0608
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist