Provider Demographics
NPI:1073012779
Name:VILLADOLID, JERYL JEAN (PHARMD, BCPS, BCOP)
Entity Type:Individual
Prefix:
First Name:JERYL
Middle Name:JEAN
Last Name:VILLADOLID
Suffix:
Gender:F
Credentials:PHARMD, BCPS, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CLARICE AVE APT 185
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2650
Mailing Address - Country:US
Mailing Address - Phone:813-601-1292
Mailing Address - Fax:
Practice Address - Street 1:1021 MOREHEAD MEDICAL DR STE 3031
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2990
Practice Address - Country:US
Practice Address - Phone:980-442-3085
Practice Address - Fax:980-442-3002
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47484183500000X
IL051295803183500000X
NC21111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist