Provider Demographics
NPI:1033630686
Name:JERNIGAN, JOHNATHAN PATRICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:PATRICK
Last Name:JERNIGAN
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 1:13390 PERDIDO KEY DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-4631
Mailing Address - Country:US
Mailing Address - Phone:850-492-5090
Mailing Address - Fax:
Practice Address - Street 1:13390 PERDIDO KEY DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-4631
Practice Address - Country:US
Practice Address - Phone:850-492-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist