Provider Demographics
NPI:1225226392
Name:WENTZ, JERALDINE G (PHARMD)
Entity Type:Individual
Prefix:
First Name:JERALDINE
Middle Name:G
Last Name:WENTZ
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 1:4230 BEE RIDGE RD
Mailing Address - Street 2:SWEETBAY SUPERMARKET PHARMACY
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2563
Mailing Address - Country:US
Mailing Address - Phone:941-343-9656
Mailing Address - Fax:941-377-4036
Practice Address - Street 1:4230 BEE RIDGE RD
Practice Address - Street 2:SWEETBAY SUPERMARKET PHARMACY
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2563
Practice Address - Country:US
Practice Address - Phone:941-343-9656
Practice Address - Fax:941-377-4036
Is Sole Proprietor?:No
Enumeration Date:2007-10-13
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist