Provider Demographics
NPI:1144229790
Name:WEDDERBURN, JAMAL KALEEM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:KALEEM
Last Name:WEDDERBURN
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 1:9324 SW 220TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1110
Mailing Address - Country:US
Mailing Address - Phone:305-233-3957
Mailing Address - Fax:
Practice Address - Street 1:12349 SW 53RD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-3338
Practice Address - Country:US
Practice Address - Phone:954-252-5556
Practice Address - Fax:954-680-1347
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist