Provider Demographics
NPI:1053637421
Name:DUFF, JEFFREY JAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JAY
Last Name:DUFF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 CYPRESS GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-4115
Mailing Address - Country:US
Mailing Address - Phone:863-326-1612
Mailing Address - Fax:863-318-9853
Practice Address - Street 1:6015 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-4115
Practice Address - Country:US
Practice Address - Phone:863-326-1612
Practice Address - Fax:863-318-9853
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-10
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102380200Medicaid