Provider Demographics
NPI:1033228093
Name:CHIA, JERRY (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:CHIA
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 1:1508 FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6511
Mailing Address - Country:US
Mailing Address - Phone:954-554-8215
Mailing Address - Fax:
Practice Address - Street 1:5599 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3406
Practice Address - Country:US
Practice Address - Phone:954-771-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist