Provider Demographics
NPI:1144568122
Name:WEEMS, JESSICA NOEL
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:NOEL
Last Name:WEEMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11551 SW 26TH ST
Mailing Address - Street 2:APT 206
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7539
Mailing Address - Country:US
Mailing Address - Phone:407-497-3599
Mailing Address - Fax:305-238-7345
Practice Address - Street 1:12100 SW 127TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4663
Practice Address - Country:US
Practice Address - Phone:305-238-5184
Practice Address - Fax:305-238-7345
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist