Provider Demographics
NPI:1164769113
Name:LEVENGOOD, JERROLD DOUGLAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:JERROLD
Middle Name:DOUGLAS
Last Name:LEVENGOOD
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 1:2685 N FOREST RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-5123
Mailing Address - Country:US
Mailing Address - Phone:352-527-6554
Mailing Address - Fax:352-527-0789
Practice Address - Street 1:2685 N FOREST RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-5123
Practice Address - Country:US
Practice Address - Phone:352-527-6554
Practice Address - Fax:352-527-0789
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist