Provider Demographics
NPI:1073066601
Name:GARRETT, JEREMY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:GARRETT
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 1:744 OLD SAN MATEO RD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:FL
Mailing Address - Zip Code:32187-2223
Mailing Address - Country:US
Mailing Address - Phone:760-415-3215
Mailing Address - Fax:
Practice Address - Street 1:744 OLD SAN MATEO RD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:FL
Practice Address - Zip Code:32187-2223
Practice Address - Country:US
Practice Address - Phone:760-415-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist