Provider Demographics
NPI:1972872711
Name:FERNANDEZ, JACQUELYN ANN (PHARMD)
Entity type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:ANN
Last Name:FERNANDEZ
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 1:19821 NW 87TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6260
Mailing Address - Country:US
Mailing Address - Phone:305-206-4846
Mailing Address - Fax:
Practice Address - Street 1:19821 NW 87TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6260
Practice Address - Country:US
Practice Address - Phone:305-206-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist