Provider Demographics
NPI:1073858700
Name:JOHN, JEWEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEWEL
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17177 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1091
Mailing Address - Country:US
Mailing Address - Phone:954-383-1377
Mailing Address - Fax:
Practice Address - Street 1:17177 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1091
Practice Address - Country:US
Practice Address - Phone:754-201-3663
Practice Address - Fax:754-201-3668
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist